MEDICARE: MEGAN LINZ 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	LCSW-30847	ID

General Provider Information

NPI Number	:	1508168345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN LINZ LCSW

Provider Business Mailing Address
First Line	:	6654 W TOBI DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-6100
Country	:	US
Telephone Number	:	208-695-3014
Fax Number	:

Provider Business Practice Location Address
First Line	:	6126 W STATE ST
Second Line	:	SUITE 106
City	:	BOISE
State	:	ID
Zip	:	83703-2741
Country	:	US
Telephone Number	:	208-695-3014
Fax Number	:

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

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	11/30/2010

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