Active NPI
Robert Siddoway, LCSW
- Clinical Social Worker
- Idaho Falls, ID
National Provider Identifier
1235523457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-34243
- Practice address
- 254 E St
Suite B
Idaho Falls, ID 83402-3527 - Phone
- (208) 339-0816
- NPI assigned
- Mar 25, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-34243 | ID | Primary |
Addresses
Primary practice location
254 E St
Suite B
Idaho Falls, ID 83402-3527
Mailing address
254 E St
Suite B
Idaho Falls, ID 83402-3527
Phone (208) 529-1854
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-34243 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Madison | Current | Accepting new patients | |
| D7 Treatment | Current | Accepting new patients |
Locations
254 E St
#B
Idaho Falls, ID 83402
Phone (208) 529-1854
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713916800000",
"number": "1235523457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "254 E ST",
"address_2": "SUITE B",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834023527",
"telephone_number": "208-529-1854",
"fax_number": "208-523-5974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "254 E ST",
"address_2": "SUITE B",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834023527",
"telephone_number": "208-339-0816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDDOWAY",
"first_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-25",
"last_updated": "2024-04-24",
"certification_date": "2024-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-34243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.