MEDICARE: MRS. WAVEY LOUISE TUCK 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-33583	ID
2	104100000X	Social Worker	LMSW-30598	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659651743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WAVEY LOUISE TUCK LCSW

Provider Business Mailing Address
First Line	:	1409 W MAIN ST STE 120
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5215
Country	:	US
Telephone Number	:	406-480-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 W MAIN ST STE 120
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5215
Country	:	US
Telephone Number	:	406-480-5800
Fax Number	:

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

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	03/11/2026

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