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General NPI Number Information
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NPI Number | 1548775232
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Entity Type | Individual
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Provider Name | CASSIE MIKAILA GARDNER-GOULD
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Gender | Female
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 8660 W EMERALD ST STE 112
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City | BOISE
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State | ID
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Zip | 83704-4829
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Country | US
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Telephone | 208-391-5345
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Fax |
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Provider Business Mailing Address
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Address Line | 3005 N 28TH ST
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City | BOISE
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State | ID
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Zip | 83703-5035
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Country | US
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Telephone | 763-639-8571
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Fax |
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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 | 6971772
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License Number State | ID
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