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NPI Code Detail

MEDICARE: MARTHA FETZER LCSW, RD, LD

MEDICARE: MARTHA FETZER LCSW, RD, LD
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 Worker8911317ID

General Provider Information

NPI Number : 1508637729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA FETZER LCSW, RD, LD
Provider Business Mailing Address
First Line : 1214 W FRANKLIN ST
Second Line :
City : BOISE
State : ID
Zip : 83702-5301
Country : US
Telephone Number : 208-569-4087
Fax Number :
Provider Business Practice Location Address
First Line : 500 W FORT ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4501
Country : US
Telephone Number : 208-422-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2024
Last Update Date : 01/30/2026

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