Healthcare Provider Details

I. General information

NPI: 1912371592
Provider Name (Legal Business Name): KIMBERLY KELZER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S ORCHARD ST STE 201
BOISE ID
83705-3713
US

IV. Provider business mailing address

2125 S PETRA AVE
BOISE ID
83709-8542
US

V. Phone/Fax

Practice location:
  • Phone: 986-270-6189
  • Fax:
Mailing address:
  • Phone: 208-250-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-38006
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: