Healthcare Provider Details

I. General information

NPI: 1114042843
Provider Name (Legal Business Name): CHALICE SILFLOW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W EMERALD ST SUITE 150
BOISE ID
83704-4810
US

IV. Provider business mailing address

8601 W EMERALD ST SUITE 150
BOISE ID
83704-4810
US

V. Phone/Fax

Practice location:
  • Phone: 208-321-0634
  • Fax: 208-321-7001
Mailing address:
  • Phone: 208-321-0634
  • Fax: 208-321-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW26601
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: