| Doctor Name: | MS. TERRI LYNN SUDOL |
| NPI Number: | 1316001621 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.W., L.C.S.W. |
| License Number: | LCSW-1215 |
| Business Practice Address: | 10615 N Government Way Ste 206 Hayden, ID - 838358027 |
| Business Phone Number: | 2087555188 |
| Business Fax Number: | 2087722533 |
| Mailing Address: | 10615 N Government Way, HAYDEN |
| State: | ID |
| Postal Code: | 838357473 |
| Phone Number: | 2087555188 |
| Fax Number: | 2087722533 |
| NPI Enumeration Date: | 12/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW-1215 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |