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NPI Code Detail

MEDICARE: DR. TRACI CRABB PSY.D.

MEDICARE: DR. TRACI CRABB PSY.D.
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
1103TC0700XClinical PsychologistPSY - 202233ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1N6289OTHERIDBLUE CROSS OF IDAHO
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000010157338OTHERIDREGENCE BLUE SHIELD OF ID

General Provider Information

NPI Number : 1336157452
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACI CRABB PSY.D.
Provider Business Mailing Address
First Line : 5418 N EAGLE RD STE 160
Second Line :
City : BOISE
State : ID
Zip : 83713-0100
Country : US
Telephone Number : 208-938-9653
Fax Number : 208-549-7870
Provider Business Practice Location Address
First Line : 5418 N EAGLE RD STE 160
Second Line :
City : BOISE
State : ID
Zip : 83713-0100
Country : US
Telephone Number : 208-938-9653
Fax Number : 208-938-1399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 08/21/2025

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