MEDICARE: RACHAEL BAZZETT LCSW

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
1	1041C0700X	Clinical Social Worker	LCSW42129	ID

General Provider Information

NPI Number	:	1437785805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL BAZZETT LCSW

Provider Business Mailing Address
First Line	:	4696 W OVERLAND RD STE 252
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-2877
Country	:	US
Telephone Number	:	208-607-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	4696 W OVERLAND RD STE 252
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-2877
Country	:	US
Telephone Number	:	208-607-3602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	04/29/2024

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