Basic Information
| Provider Information | |||||||||
| NPI: | 1891244455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIARD | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6191 N BANDON PL | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837144057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086295468 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1550 N CRESTMONT DR | ||||||||
| Address2: | STE A | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836422184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082884200 | ||||||||
| FaxNumber: | 2082884279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2016 | ||||||||
| LastUpdateDate: | 09/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 33616 | ID | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.