Healthcare Provider Details

I. General information

NPI: 1245000231
Provider Name (Legal Business Name): RACHEL BARNUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 E FAIRVIEW AVE
MERIDIAN ID
83642-1806
US

IV. Provider business mailing address

849 E FAIRVIEW AVE
MERIDIAN ID
83642-1806
US

V. Phone/Fax

Practice location:
  • Phone: 661-827-7177
  • Fax:
Mailing address:
  • Phone: 661-827-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3981411
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: