Individual
MICHELLE CASELLA BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4949 S HILLSDALE AVE, MERIDIAN, ID 83642-7586
(208) 706-6400
(208) 706-6411
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
37304
ID
1041C0700X
Clinical Social Worker
Primary
8851960
ID
Other
Enumeration date
09/18/2024
Last updated
11/11/2024
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