Healthcare Provider Details

I. General information

NPI: 1376300723
Provider Name (Legal Business Name): GABRIELLE ROSE MESSICK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLE ROSE RENDON

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 E. FLAMINGO AVE. CLINICAL RESOURCE MANAGEMENT
83687 ID
83687
US

IV. Provider business mailing address

4300 E FLAMINGO AVE
NAMPA ID
83687-3138
US

V. Phone/Fax

Practice location:
  • Phone: 208-590-6628
  • Fax:
Mailing address:
  • Phone: 208-565-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8911443
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: