Provider Demographics
NPI:1063290013
Name:THE REGENTS OF THE UNIVERSITY OF IDAHO
Entity type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF IDAHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISROE-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-287-5900
Mailing Address - Street 1:5880 N GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1342
Mailing Address - Country:US
Mailing Address - Phone:120-889-0787
Mailing Address - Fax:
Practice Address - Street 1:5880 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1342
Practice Address - Country:US
Practice Address - Phone:208-287-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health