Healthcare Provider Details

I. General information

NPI: 1144100041
Provider Name (Legal Business Name): RANDI L FRAZIER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NORTHWEST BLVD STE 101
COEUR D ALENE ID
83814-2974
US

IV. Provider business mailing address

1203 N HENRY ST
POST FALLS ID
83854-6548
US

V. Phone/Fax

Practice location:
  • Phone: 208-660-1601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9421127
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: