Ms Kristy Lee Broncho, LCSW | |
Mission Road Blding 248, Fort Hall Indian Agency, Fort Hall, ID 83203 | |
(208) 237-5631 | |
(208) 237-5796 |
Full Name | Ms Kristy Lee Broncho |
---|---|
Gender | Female |
Speciality | Social Worker - Clinical |
Location | Mission Road Blding 248, Fort Hall, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1932323045 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | LCSW-24506 (Idaho) | Primary |
Entity Name | Shoshone Bannock Tribes Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1801949763 PECOS PAC ID: 5496804429 Enrollment ID: O20100330001318 |
Mailing Address | Practice Location Address |
---|---|
Ms Kristy Lee Broncho, LCSW Rr 6 Box 918, Pocatello, ID 83202-9549 Ph: (208) 637-8032 | Ms Kristy Lee Broncho, LCSW Mission Road Blding 248, Fort Hall Indian Agency, Fort Hall, ID 83203 Ph: (208) 237-5631 |
Akaila Martin, MSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 29 N Mission Road #240, Fort Hall, ID 83203 Phone: 208-478-4026 Fax: 208-478-4022 | |
Mr. Thayne Andersen, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 717 Mission Road, Fort Hall, ID 83203 Phone: 208-237-5631 Fax: 208-237-5796 | |
Daniel Jerome Hall, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 717 Mission Road, Fort Hall, ID 83203 Phone: 208-237-5631 Fax: 208-237-5796 | |
Ms. Shari L. Newsome, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: Mission Road Building 248, Fort Hall Indian Agency, Fort Hall, ID 83203 Phone: 208-237-5631 Fax: 208-237-5796 | |
Jessie A Bacon, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: Mission Road Blding 248, Fort Hall Indian Agency, Fort Hall, ID 83203 Phone: 208-237-5631 Fax: 208-237-5796 | |
Matthew J Wadsworth, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 717 Mission Road, Fort Hall, ID 83203 Phone: 208-237-5631 Fax: 208-237-5796 |