Basic Information
| Provider Information | |||||||||
| NPI: | 1770957938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGER | ||||||||
| FirstName: | SONJA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3648 | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838162522 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 14775 N KIMO CT | ||||||||
| Address2: | SUITE B | ||||||||
| City: | RATHDRUM | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838588762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086875627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2015 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-27707 | ID | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | LCSW-27707 | 01 | ID | ID LICENSE | OTHER |