MEDICARE: SHAELYN GRIFFIN

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

General Provider Information

NPI Number	:	1871179341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAELYN GRIFFIN

Provider Business Mailing Address
First Line	:	1650 S TOPAZ WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-4474
Country	:	US
Telephone Number	:	208-605-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	10787 W USTICK RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5104
Country	:	US
Telephone Number	:	208-672-1801
Fax Number	:

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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Directions to “ SHAELYN GRIFFIN ” Practice Location

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