Healthcare Provider Details

I. General information

NPI: 1821352378
Provider Name (Legal Business Name): KARA M KREIZENBECK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 E BLUE TICK ST
MERIDIAN ID
83642-4547
US

IV. Provider business mailing address

1941 E BLUE TICK ST
MERIDIAN ID
83642-4547
US

V. Phone/Fax

Practice location:
  • Phone: 208-283-1443
  • Fax:
Mailing address:
  • Phone: 208-283-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-33383
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: