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General NPI Number Information
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NPI Number | 1154404341
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Entity Type | Individual
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Provider Name | GAIL M BACCHESCHI MSW
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1408 WEST HAYS STREET
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-343-1403
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Fax | 208-336-7125
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Provider Business Mailing Address
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Address Line | 1408 WEST HAYS STREET
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-343-1403
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Fax | 208-336-7125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW522
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1257103501
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License Number State | UT
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