BOISE BRAIN HEALTH (NPI# 1790241404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790241404 |
| Entity Type | Organization |
| Organization Name | BOISE BRAIN HEALTH |
| Practice Address |
4696 W Overland Rd Ste 228 Boise ID 83705-2864 |
| Practice Telephone | 2089171692 |
| Practice Fax Number | 2089147643 |
| Mailing Telephone | 2089171692 |
| Mailing Fax Number | 2089147643 |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2019-02-18 |
| Authorized Official Name | DR. SARAH D MARION (MANAGING MEMBER) |
| Authorized Official Telephone | 2089171692 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers |
| Street Address |
4696 W OVERLAND RD STE 228 |
| City | BOISE |
| State | ID |
| Zip Code | 83705-2864 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417175589 | Heather L Robinson | Speech-Language Pathologist | 4696 W Overland Rd Ste 228, Boise, ID 83705-2864 | 2007-04-23 |
| 1356965941 | Idaho Face & Voice, LLC | Speech-Language Pathologist | 4696 W Overland Rd Ste 228, Boise, ID 83705-2864 | 2020-05-30 |
| 1063990679 | Celeste Lacombe Nelson | Social Worker | 4696 W Overland Rd Ste 228, Boise, ID 83705-2864 | 2018-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938779 | Halo Health Services LLC | Community/Behavioral Health | 1111 S Orchard St, Boise, Id 83705, Boise, ID 83705 | 2020-06-29 |
| 1598265860 | Felica Jo Duce | Counselor | 921 S Orchard St Ste 103, Boise, ID 83705 | 2018-02-13 |
| 1215364278 | Erica Zelickowski | Pharmacist | 1653 S Vista Avenue, Boise, ID 83705 | 2013-10-04 |
| 1952655490 | Aida Dizdar-barac | Social Worker | 2273 S. Vista Avenue, Suite 190, Boise, ID 83705 | 2012-11-06 |
| 1033461033 | Julie Marie Meek | Social Worker | 3324 W Elder St, Boise, ID 83705 | 2012-10-15 |
| 1568761112 | Berkeley Fraser | Pharmacist | 3527 S Federal Way Suite 104, Boise, ID 83705 | 2011-03-22 |
| 1922311042 | Amber Vania | Family Medicine | 4971 W. Overland Road, Boise, ID 83705 | 2010-07-18 |
| 1295056836 | Cherise M Wetzel | Social Worker | 1625 S Eagleson Rd, B1, Boise, ID 83705 | 2010-06-17 |
| 1558685305 | Rae Ann Norell | Social Worker | 2273 S. Vista Ave, #190 Treasure Valley Community Counseling Services, Boise, ID 83705 | 2010-03-23 |
| 1164679932 | Oreana Harless | Social Worker | 2550 South Vista Ave, Boise, ID 83705 | 2008-08-25 |
| Find all providers in zip 83705 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295954485 | Saint Alphonsus Regional Medical Center Inc | Clinical Neuropsychologist | 717 N Liberty St, Boise, ID 83704-9342 | 2007-04-25 |
| 1952443640 | Christine Pickford | Clinical Neuropsychologist | 1104 N 18th St, Boise, ID 83702-3321 | 2007-02-12 |
| 1225176498 | Craig W. Beaver | Clinical Neuropsychologist | 250 Bobwhite Ct Ste 220, Boise, ID 83706-3983 | 2007-02-01 |
| 1326008053 | David E Nilsson | Clinical Neuropsychologist | 2537 W. State St., Suite 210, Boise, ID 83702 | 2006-03-25 |
| 1215305263 | Cynthia Tremblay | Clinical Neuropsychologist | 600 N Robbins Rd, Boise, ID 83702-4565 | 2015-09-08 |
| 1154665123 | Merry Sylvester | Clinical Neuropsychologist | 1055 N Curtis Rd, Boise, ID 83706-1309 | 2012-11-15 |
| 1659631562 | Brienne M Dyer | Clinical Neuropsychologist | 500 W Fort St, (b114), Boise, ID 83702-4501 | 2012-05-24 |
| 1275891194 | David E. Nilsson, Ph.d., P.C. | Clinical Neuropsychologist | 950 W Bannock St Ste 1100, Boise, ID 83702-6140 | 2012-04-28 |
| 1316241417 | Jeff Alan Sordahl Jr. | Clinical Neuropsychologist | 500 W Fort St, Boise, ID 83702-4501 | 2011-01-04 |
| 1265677298 | Amy E. Latta, Ph.d., P.a. | Clinical Neuropsychologist | 1020 W Main St, Suite 100b, Boise, ID 83702-5789 | 2008-12-04 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.