ROBERT ANDREW DE WALL (NPI# 1114228384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114228384 |
| Entity Type | Individual |
| Full Name | ROBERT ANDREW DE WALL |
| Credential | LCPC |
| Practice Address |
444 Hospital Way Ste 477 Pocatello ID 83201-2744 |
| Mailing Address |
65 Fordham St Pocatello ID 83201-3418 |
| Practice Telephone | 2082337832 |
| Practice Fax Number | 2082337835 |
| Mailing Telephone | 2083170027 |
| Mailing Fax Number | 2082342800 |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2019-08-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LCPC-4672 | ID | Behavioral Health & Social Service Providers |
| Street Address |
444 HOSPITAL WAY STE 477 |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-2744 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952917353 | Wende Christine Leavitt | Physician Assistant | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2020-09-21 |
| 1669082665 | Maggie Gardner | Counselor | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2020-08-04 |
| 1225655277 | Ashley Brianne Rohrbach | Counselor | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2020-06-25 |
| 1588219497 | Elizabeth Macklin | Counselor | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2019-08-07 |
| 1285289207 | Olivia Theresa Ngadjui | Counselor | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2019-08-06 |
| 1043783368 | Amber Carolynn Malay | Case Manager/Care Coordinator | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2019-01-09 |
| 1912489980 | Renee Gault | Nurse Practitioner | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2018-09-05 |
| 1801384847 | Vincent Marasco | Counselor | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2018-04-25 |
| 1750887394 | Shawn Grischkowsky | Peer Specialist | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2018-04-03 |
| 1760980023 | Lisa Gay Johnston | Peer Specialist | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2018-01-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669081311 | Catherine Leavitt | Counselor | 921 S 8th Ave # 8136, Pocatello, ID 83209-0002 | 2020-07-29 |
| 1407363690 | Kimberly B Rasmussen, Pllc | Counselor | 850 E Center St Ste F, Pocatello, ID 83201-5737 | 2018-01-09 |
| 1508396714 | Steven Richard Miner | Counselor | 440 E Clark St Ste A, Pocatello, ID 83201-6308 | 2017-06-20 |
| 1306210398 | Amanda Bland | Counselor | 1133 Rowland Rd, Pocatello, ID 83204-7416 | 2015-11-14 |
| 1962804757 | Gary Sean Redford | Counselor | 12930 N Rio Vista Rd, Pocatello, ID 83202-5007 | 2014-09-23 |
| 1750781449 | Jennifer Lynn Seaich | Counselor | 4460 Center Way, Center Counseling, Pocatello, ID 83202 | 2014-08-29 |
| 1437585189 | Shayla F Ward | Counselor | 459 S Arthur Ave, Pocatello, ID 83204-3303 | 2013-09-25 |
| 1366781262 | Gail Taylor Thorngren | Counselor | 201 E Center St Ste B, Pocatello, ID 83201-6339 | 2013-02-12 |
| 1851650691 | Christine Collaer-muzzo | Counselor | 120 S 12th Ave Ste 4, Pocatello, ID 83201-4814 | 2012-05-14 |
| 1164780706 | Kimberly Jo Andrew | Counselor | 421 E Oak St, Pocatello, ID 83201-4601 | 2012-05-02 |
| Find all providers in POCATELLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.