MEDICARE: JODI COPELAND BSW

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861232472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI COPELAND BSW

Provider Business Mailing Address
First Line	:	1036 E IRON EAGLE DR STE 166
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6557
Country	:	US
Telephone Number	:	986-217-4584
Fax Number	:	208-718-2385

Provider Business Practice Location Address
First Line	:	1036 E IRON EAGLE DR STE 166
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6557
Country	:	US
Telephone Number	:	986-217-4584
Fax Number	:	208-718-2385

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

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	06/20/2024

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