Provider Demographics
NPI:1053989947
Name:RIDER, ALISON NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:NICOLE
Last Name:RIDER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 W LOVEJOY ST APT 7
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3462
Mailing Address - Country:US
Mailing Address - Phone:208-251-4776
Mailing Address - Fax:
Practice Address - Street 1:151 N 3RD AVE STE 330
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6369
Practice Address - Country:US
Practice Address - Phone:208-242-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-453901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical