MEDICARE: NAOMI NELSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LMSW-44056	ID
2	1041C0700X	Clinical Social Worker	8911430	ID

General Provider Information

NPI Number	:	1316722911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI NELSON LCSW

Provider Business Mailing Address
First Line	:	2208 N FREEWATER AVE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-6625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2068 S EAGLE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6707
Country	:	US
Telephone Number	:	208-340-1688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	06/01/2026

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Directions to “ NAOMI NELSON LCSW” Practice Location

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