Healthcare Provider Details

I. General information

NPI: 1912554395
Provider Name (Legal Business Name): CONNIE ENRIQUEZ-OROZCO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W ST LUKES DR STE 320
NAMPA ID
83687-7912
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-2222
  • Fax: 208-205-7666
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861022
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: