Healthcare Provider Details

I. General information

NPI: 1831029719
Provider Name (Legal Business Name): GRACIE GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 N COLE RD STE 270
BOISE ID
83704-5991
US

IV. Provider business mailing address

2995 N COLE RD STE 270
BOISE ID
83704-5991
US

V. Phone/Fax

Practice location:
  • Phone: 208-576-6464
  • Fax: 208-392-1378
Mailing address:
  • Phone: 208-576-6464
  • Fax: 208-392-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4281510
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: