Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 36743 | ID |
NPI | 1003339359 |
---|---|
Provider Name | Ms. Bennett Rachel Munoz |
First Address | Boise, ID 83703-4614 |
Second Address | Boise, ID 83706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2017 |
Last Update Date | 19/07/2017 |