Healthcare Provider Details

I. General information

NPI: 1043121676
Provider Name (Legal Business Name): CAITLYN ELIZABETH BROTZMAN BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 W RIVER ST STE 100
BOISE ID
83702-7083
US

IV. Provider business mailing address

1276 W RIVER ST STE 100
BOISE ID
83702-7083
US

V. Phone/Fax

Practice location:
  • Phone: 208-671-5744
  • Fax:
Mailing address:
  • Phone: 208-671-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: