MEDICARE: LINDA K ROGERS-PERKINS 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	LCSW27602	ID

General Provider Information

NPI Number	:	1528120789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA K ROGERS-PERKINS LCSW

Provider Business Mailing Address
First Line	:	140 TRAILBLAZER ST
Second Line	:
City	:	MIDDLETON
State	:	ID
Zip	:	83644-4903
Country	:	US
Telephone Number	:	208-398-3067
Fax Number	:

Provider Business Practice Location Address
First Line	:	9628 W STATE ST
Second Line	:
City	:	STAR
State	:	ID
Zip	:	83669-5858
Country	:	US
Telephone Number	:	208-398-3067
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/24/2021

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