Provider Demographics
NPI:1952487407
Name:KNAPP, JULENE BURROWS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULENE
Middle Name:BURROWS
Last Name:KNAPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 BROADWAY
Mailing Address - Street 2:SUITE 435
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3690
Mailing Address - Country:US
Mailing Address - Phone:208-338-1227
Mailing Address - Fax:208-338-1228
Practice Address - Street 1:960 BROADWAY
Practice Address - Street 2:SUITE 435
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3690
Practice Address - Country:US
Practice Address - Phone:208-338-1227
Practice Address - Fax:208-338-1228
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW67104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010015743OtherBLUE SHIELD ID
IDL0676OtherBLUE CROSS ID
1690399Medicare ID - Type Unspecified