Healthcare Provider Details

I. General information

NPI: 1861327785
Provider Name (Legal Business Name): KATHERINE ACEVEDO SALAZAR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6003 W OVERLAND RD STE 105
BOISE ID
83709-3075
US

IV. Provider business mailing address

3278 E RENWICK ST
MERIDIAN ID
83642-6467
US

V. Phone/Fax

Practice location:
  • Phone: 208-417-8428
  • Fax: 208-216-1434
Mailing address:
  • Phone: 208-417-8428
  • Fax: 208-216-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6281916
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: