Provider Demographics
NPI:1093357345
Name:GILMORE, CIARA MARIE
Entity Type:Individual
Prefix:MRS
First Name:CIARA
Middle Name:MARIE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12577 W IRVING ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2203
Mailing Address - Country:US
Mailing Address - Phone:208-407-9677
Mailing Address - Fax:
Practice Address - Street 1:12577 W IRVING ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2203
Practice Address - Country:US
Practice Address - Phone:208-407-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician