Individual
JOSE GERARDO PACHECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW, MSW
Contact information
Practice address
4750 N FIVE MILE RD, BOISE, ID 83713-2715
(208) 996-0931
Mailing address
4750 N FIVE MILE RD, BOISE, ID 83713-2715
(208) 614-9448
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LW61310284
WA
1041C0700X
Clinical Social Worker
Primary
5761478
ID
Other
Enumeration date
10/09/2018
Last updated
03/19/2025
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