Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1041C0700X | Social Worker | Clinical | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 39026 | OTHER | | UNITED MEDICAL RESOURCES |
| 2 | 93029 | OTHER | IDAHO | PACIFICSOURCE HEALTH PLANS |
| 3 | IDBLC | OTHER | IDAHO | BLUE CROSS BLUE SHIELD OF IDAHO |
| 4 | NCBLS | OTHER | IDAHO | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA |
| 5 | RGBLS | OTHER | IDAHO | REGENCE BLUE SHIELD OF WASHINGTON |
| 6 | IDBLS | OTHER | IDAHO | BLUE SHIELD OF IDAHO |
| 7 | RGA01 | OTHER | | REGENCE GROUP ADMINISTRATORS |
| 8 | UH107 | OTHER | | SELECTHEALTH |
| 9 | 39026 | OTHER | | UMR |
| 10 | SX155 | OTHER | IDAHO | MOUNTAIN HEALTH CO-OP |
| 11 | 84076 | OTHER | | SINCLAIR HEALTH PLAN |
| 12 | IDBLC | OTHER | | BLUE CROSS OF IDAHO |
| 13 | WABLC | OTHER | | WASHINGTON STATE PREMERA BLUE CROSS |
| 14 | 60054 | OTHER | IDAHO | AETNA |
| 15 | SX155 | OTHER | | UNIVERSITY OF UTAH HEALTH PLANS |
| 16 | SX155 | OTHER | | UNIVERSITY OF UTAH |
| 17 | BC001 | OTHER | | ANTHEM BLUE CROSS OF CALIFORNIA |
| 18 | UH107 | OTHER | | SELECT HEALTH IHC INTERMOUNTAIN HEALTH |
