Healthcare Provider Details

I. General information

NPI: 1144141243
Provider Name (Legal Business Name): AIME CLARICE MUNTZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 11TH AVE E
GOODING ID
83330-5368
US

IV. Provider business mailing address

605 11TH AVE E
GOODING ID
83330-5368
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-8461
  • Fax: 208-934-5437
Mailing address:
  • Phone: 208-934-8461
  • Fax: 208-934-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4381421
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: