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General NPI Number Information
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NPI Number | 1225695992
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Entity Type | Individual
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Provider Name | DIANNE GRACE PIGGOTT
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Gender | Female
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 3350 W AMERICANA TERRACE SUITE #215
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City | BOISE
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State | ID
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Zip | 83706-2521
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Country | US
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Telephone | 208-509-3008
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Fax | 208-509-3009
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Provider Business Mailing Address
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Address Line | 41 W HIGHWAY 14 UNIT 2515
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City | SPEARFISH
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State | SD
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Zip | 57783-1148
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Country | US
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Telephone | 208-509-3008
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Fax | 208-509-3009
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7296LPC-
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License Number State | ID
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