| Wildflower Intuitive Center, Llc | |
|
4696 W Overland Rd Ste 276 Boise ID 83705-2877 | |
| (208) 722-2200 | |
| (208) 912-0325 |
| Full Name | Wildflower Intuitive Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4696 W Overland Rd Ste 276, Boise, Idaho |
| Authorized Official Name and Position | Corie Sue Cook (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2087222200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildflower Intuitive Center, Llc 4696 W Overland Rd Ste 276 Boise ID 83705-2877 Ph: (208) 722-2200 | Wildflower Intuitive Center, Llc 4696 W Overland Rd Ste 276 Boise ID 83705-2877 Ph: (208) 722-2200 |
| NPI Number | 1235774407 |
|---|---|
| Provider Enumeration Date | 11/12/2019 |
| Last Update Date | 11/12/2019 |
| Medicare PECOS PAC ID | 4789006305 |
|---|---|
| Medicare Enrollment ID | O20200626000854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235774407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Corie Sue Cook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487711305 PECOS PAC ID: 5698197218 Enrollment ID: I20200626000894 |
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