| Pathways Of Idaho, Llc | |
|
545 N Benjamin Ln Ste 185 Boise ID 83704-9625 | |
| (208) 322-1026 | |
| (208) 322-1029 |
| Full Name | Pathways Of Idaho, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 545 N Benjamin Ln Ste 185, Boise, Idaho |
| Authorized Official Name and Position | Ryan Jones (IDAHO STATE DIRECTOR) |
| Authorized Official Contact | 2083221026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathways Of Idaho, Llc 545 N Benjamin Ln Ste 185 Boise ID 83704-9625 Ph: (208) 322-1026 | Pathways Of Idaho, Llc 545 N Benjamin Ln Ste 185 Boise ID 83704-9625 Ph: (208) 322-1026 |
| NPI Number | 1326466988 |
|---|---|
| Provider Enumeration Date | 04/01/2014 |
| Last Update Date | 06/20/2024 |
| Certification Date | 05/31/2024 |
| Medicare PECOS PAC ID | 4789808759 |
|---|---|
| Medicare Enrollment ID | O20140612001789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326466988 | NPI | - | NPPES |
| 20004720 | Other | ID | MEDICARE PTAN |
| Provider Name | Jody A Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821352329 PECOS PAC ID: 3971758020 Enrollment ID: I20130221000515 |
| Provider Name | Sharon L Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598189821 PECOS PAC ID: 1658594049 Enrollment ID: I20140604000901 |
| Provider Name | Shannon Binder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710386396 PECOS PAC ID: 4688895527 Enrollment ID: I20141017002390 |
| Provider Name | Susan Martinelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366629388 PECOS PAC ID: 9335216068 Enrollment ID: I20150909002371 |
| Provider Name | Susan C Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477837698 PECOS PAC ID: 1254692593 Enrollment ID: I20180228001911 |
| Provider Name | Amanda L Jacobs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760946289 PECOS PAC ID: 7810355583 Enrollment ID: I20230628001550 |
| Provider Name | Rachael J Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437766805 PECOS PAC ID: 7618329335 Enrollment ID: I20240118002280 |
| Provider Name | Kara J Hudson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427487479 PECOS PAC ID: 6507200110 Enrollment ID: I20240221003685 |
| Provider Name | Elisabeth A Pederson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578286407 PECOS PAC ID: 9133566649 Enrollment ID: I20240320000758 |
| Provider Name | Alex L North |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841941291 PECOS PAC ID: 6901245828 Enrollment ID: I20240411002529 |
| Provider Name | Douglas J Shey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821391525 PECOS PAC ID: 5698114338 Enrollment ID: I20240415002371 |
| Provider Name | Veronica M Grimaldo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720799612 PECOS PAC ID: 4587109152 Enrollment ID: I20240709000507 |
| Provider Name | Dawn M Kangas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386413995 PECOS PAC ID: 2769902337 Enrollment ID: I20250226001145 |
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