Provider Demographics
NPI:1598725277
Name:BILD, RENEE OURS (MSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:OURS
Last Name:BILD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:LYNNE
Other - Last Name:OURS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1718 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3949
Mailing Address - Country:US
Mailing Address - Phone:208-336-3031
Mailing Address - Fax:208-336-3228
Practice Address - Street 1:1718 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3949
Practice Address - Country:US
Practice Address - Phone:208-336-3031
Practice Address - Fax:208-336-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
80-0854651OtherIRS TIN