Provider Demographics
NPI:1942768676
Name:REEDY, AMANDA RAE BELZER (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE BELZER
Last Name:REEDY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:BELZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:500 W BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5916
Mailing Address - Country:US
Mailing Address - Phone:719-210-5479
Mailing Address - Fax:
Practice Address - Street 1:500 W BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5916
Practice Address - Country:US
Practice Address - Phone:719-210-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-40449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker