Provider Demographics
NPI:1013379536
Name:BALZER, AMY NIBLOCK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NIBLOCK
Last Name:BALZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 N WESTGATE DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7164
Mailing Address - Country:US
Mailing Address - Phone:208-334-0874
Mailing Address - Fax:208-334-0812
Practice Address - Street 1:1720 N WESTGATE DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7164
Practice Address - Country:US
Practice Address - Phone:208-334-0874
Practice Address - Fax:208-334-0812
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID795 - LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical