Individual
REBECCA E HEADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
610 W HAYS ST, BOISE, ID 83702-5511
(208) 381-6995
Mailing address
610 W HAYS ST, BOISE, ID 83702-5511
(208) 381-6995
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-32694
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-38616
ID
Other
Enumeration date
03/21/2013
Last updated
04/21/2020
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