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SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC

Clinical Neuropsychologist

Boise, Idaho

Provider NPI: 1295954485

Organization Information:
Organization Name:  SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
Organization is Subpart
Authorized Official:  ODETTE  BOLANO  PRESIDENT  208-3672118

Practice Location:
717 N LIBERTY ST  BOISE, ID 83704 US
Tel: 208-367-8989  Fax: 208-367-8944

Business Mailing Address:
901 N CURTIS RD STE 204 BOISE, ID 83706 US
Tel: 208-367-8950  Fax: 208-367-6908

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
ID2
N111NR0400XChiropractic Providers
Chiropractor
ID2
N225800000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Recreation Therapist
ID2
N225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Occupational Therapist
ID2
N2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Respiratory Therapist, Certified
ID2
N235Z00000XSpeech, Language and Hearing Service Providers
Speech-Language Pathologist
ID2
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
ID2

Other Provider Identifiers:

IssuerNumberStateType
002265701ID05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS ID - Page 1



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