Individual
BRET V. WIXOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24803
ID
1041C0700X
Clinical Social Worker
5450383-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010143064
REGENCE BLUE SHIELD OF ID
ID
01
—
L2649
BLUE CROSS OF IDAHO
ID
Enumeration date
10/02/2006
Last updated
04/14/2026
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