Healthcare Provider Details

I. General information

NPI: 1558798710
Provider Name (Legal Business Name): GAIL L ZICKEFOOSE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 N EAGLE RD
BOISE ID
83713-5005
US

IV. Provider business mailing address

16548 SNOWGOOSE ST
NAMPA ID
83687-8293
US

V. Phone/Fax

Practice location:
  • Phone: 208-570-4350
  • Fax:
Mailing address:
  • Phone: 208-570-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5337
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: