Provider Demographics
NPI:1932483260
Name:BOSCH, REBECCA (LCPC, QP, NCC, CRC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BOSCH
Suffix:
Gender:F
Credentials:LCPC, QP, NCC, CRC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:CADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:
Practice Address - Street 1:1809 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5873
Practice Address - Country:US
Practice Address - Phone:086-205-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional