Provider Demographics
NPI:1295056836
Name:WETZEL, CHERISE M (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHERISE
Middle Name:M
Last Name:WETZEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S EAGLESON RD
Mailing Address - Street 2:B1
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2750
Mailing Address - Country:US
Mailing Address - Phone:208-249-5913
Mailing Address - Fax:
Practice Address - Street 1:1625 S EAGLESON RD
Practice Address - Street 2:B1
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:108-249-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker