Healthcare Provider Details

I. General information

NPI: 1124951751
Provider Name (Legal Business Name): CAMILLE MOON COOK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 E 154 N
RIGBY ID
83442-5727
US

IV. Provider business mailing address

3929 E 154 N
RIGBY ID
83442-5727
US

V. Phone/Fax

Practice location:
  • Phone: 208-270-3299
  • Fax:
Mailing address:
  • Phone: 208-270-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: