Healthcare Provider Details

I. General information

NPI: 1093992794
Provider Name (Legal Business Name): DEGOLIA MONZELLO JOHNSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 N COLE RD STE 150
BOISE ID
83704-5965
US

IV. Provider business mailing address

1355 S LINDA VISTA AVE
BOISE ID
83709-1531
US

V. Phone/Fax

Practice location:
  • Phone: 208-703-7357
  • Fax: 208-712-6778
Mailing address:
  • Phone: 208-761-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLMSW-25840
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-25840
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: