Provider Demographics
NPI:1275744658
Name:GILMAN, VIRGINIA (M ED)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:GILMAN
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:GILMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M ED
Mailing Address - Street 1:9750 KLONDIKE CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1527
Mailing Address - Country:US
Mailing Address - Phone:208-830-6038
Mailing Address - Fax:208-378-8852
Practice Address - Street 1:9750 KLONDIKE CT
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1527
Practice Address - Country:US
Practice Address - Phone:208-830-6038
Practice Address - Fax:208-378-8852
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-95101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ2735OtherBLUE CROSS
IDLCPC-95OtherIDAHO STATE LIC NUMBER
ID000010015793OtherBLUE SHIELD