Provider Demographics
NPI:1861908501
Name:WOLD, PATTY H (LMSW)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:H
Last Name:WOLD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3197
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-6197
Mailing Address - Country:US
Mailing Address - Phone:208-830-0702
Mailing Address - Fax:
Practice Address - Street 1:125 COMMERCE ST STE B
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5192
Practice Address - Country:US
Practice Address - Phone:208-830-0702
Practice Address - Fax:208-830-0702
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker