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General NPI Number Information
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NPI Number | 1174916969
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Entity Type | Organization
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Legal Business Name | RENEE O. BILD, PLLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 1718 W JEFFERSON ST
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City | BOISE
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State | ID
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Zip | 83702-3949
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Country | US
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Telephone | 208-336-3031
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Fax | 208-336-3228
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Provider Business Mailing Address
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Address Line | 1718 W JEFFERSON ST
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City | BOISE
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State | ID
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Zip | 83702-3949
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Country | US
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Telephone | 208-336-3031
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Fax | 208-336-3228
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Authorized Official
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Title or Position | OWNER
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Name | RENEE BILD
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Credential |
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Telephone | 208-336-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1338
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License Number State | ID
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