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NPI Code Detail

MEDICARE: MRS. REBECCA LEE WILSEY LSW

MEDICARE:  MRS. REBECCA LEE WILSEY  LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLSW-29817ID

General Provider Information

NPI Number : 1104053230
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA LEE WILSEY LSW
Provider Business Mailing Address
First Line : 6104 W EVERETT ST
Second Line :
City : BOISE
State : ID
Zip : 83704-7701
Country : US
Telephone Number : 208-409-2751
Fax Number :
Provider Business Practice Location Address
First Line : 740 WARM SPRINGS AVE
Second Line :
City : BOISE
State : ID
Zip : 83712-6420
Country : US
Telephone Number : 208-343-7797
Fax Number : 208-343-0064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2009
Last Update Date : 06/16/2009

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Directions to “ MRS. REBECCA LEE WILSEY LSW” Practice Location

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