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NPI Code Detail

MEDICARE: HEATHER LOUISE CARRIZALES CADC

MEDICARE:   HEATHER LOUISE CARRIZALES  CADC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCADC-5032ID

General Provider Information

NPI Number : 1548999410
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LOUISE CARRIZALES CADC
Provider Business Mailing Address
First Line : 2607 S MONTANA AVE
Second Line :
City : CALDWELL
State : ID
Zip : 83605-5722
Country : US
Telephone Number : 208-854-9758
Fax Number :
Provider Business Practice Location Address
First Line : 524 S 9TH AVE STE 103
Second Line :
City : CALDWELL
State : ID
Zip : 83605-5072
Country : US
Telephone Number : 208-854-9758
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2022
Last Update Date : 06/07/2022

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Directions to “ HEATHER LOUISE CARRIZALES CADC” Practice Location

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