Provider Demographics
NPI:1215148937
Name:BANKARD, KELLY RACHEL (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:RACHEL
Last Name:BANKARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:RACHEL
Other - Last Name:PAPARARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4058 N HAWTHORNE WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3923
Mailing Address - Country:US
Mailing Address - Phone:619-994-1198
Mailing Address - Fax:
Practice Address - Street 1:2500 W KOOTENAI ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2408
Practice Address - Country:US
Practice Address - Phone:208-908-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
ID418941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical