Provider Demographics
NPI:1962862797
Name:BLOXHAM, BECKY L I (LSW)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:L
Last Name:BLOXHAM
Suffix:I
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 POLE LINE RD
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3035
Mailing Address - Country:US
Mailing Address - Phone:208-814-7609
Mailing Address - Fax:208-814-7615
Practice Address - Street 1:601 POLE LINE RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3035
Practice Address - Country:US
Practice Address - Phone:208-814-7609
Practice Address - Fax:208-814-7615
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1068104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker