Individual
BRET V. WIXOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4344 E NIBLEY CIR, IDAHO FALLS, ID 83401-3783
(208) 521-4433
(208) 538-2233
Mailing address
4344 E NIBLEY CIR, IDAHO FALLS, ID 83401-3783
(208) 521-4433
(208) 538-2233
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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