Healthcare Provider Details

I. General information

NPI: 1356217855
Provider Name (Legal Business Name): CATHERINE ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 W OVERLAND RD STE 110
BOISE ID
83709-1429
US

IV. Provider business mailing address

10101 W OVERLAND RD STE 110
BOISE ID
83709-1429
US

V. Phone/Fax

Practice location:
  • Phone: 208-333-9578
  • Fax: 208-333-9582
Mailing address:
  • Phone: 208-333-9578
  • Fax: 208-333-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: