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NPI Code Detail

MEDICARE: SHAWN GARY NIELSEN LMSW

MEDICARE: SHAWN GARY NIELSEN LMSW
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
11041C0700XClinical Social WorkerLMSW 24544ID

General Provider Information

NPI Number : 1285954313
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN GARY NIELSEN LMSW
Provider Business Mailing Address
First Line : 1276 W RIVER ST STE 100
Second Line :
City : BOISE
State : ID
Zip : 83702-7083
Country : US
Telephone Number : 208-338-4699
Fax Number : 208-322-4722
Provider Business Practice Location Address
First Line : 1276 W RIVER ST STE 100
Second Line :
City : BOISE
State : ID
Zip : 83702-7083
Country : US
Telephone Number : 208-338-4699
Fax Number : 208-322-4722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2010
Last Update Date : 06/11/2010

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Directions to “ SHAWN GARY NIELSEN LMSW” Practice Location

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