MEDICARE: JANESSA LYNETTE LAZAR

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	103K00000X	Behavior Analyst	1-23-67389	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861995979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANESSA LYNETTE LAZAR

Provider Business Mailing Address
First Line	:	1404 W IDAHO ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 W IDAHO ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5002
Country	:	US
Telephone Number	:	208-968-7470
Fax Number	:

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

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	01/29/2026

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