Provider Demographics
NPI:1316052319
Name:PAGE, BOBETTE R (LCSW)
Entity type:Individual
Prefix:MS
First Name:BOBETTE
Middle Name:R
Last Name:PAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BOBBI
Other - Middle Name:
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:393 E RIVERSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7124
Mailing Address - Country:US
Mailing Address - Phone:435-359-2364
Mailing Address - Fax:408-356-1742
Practice Address - Street 1:393 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6995
Practice Address - Country:US
Practice Address - Phone:435-359-2364
Practice Address - Fax:408-356-1742
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID273731041C0700X
UT13159649-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8N122OtherBLUE CROSS OF IDAHO
ID208000867OtherIDAHO PHYSICIANS NETWORK
ID807700600Medicaid
ID2257711OtherCIGNA BEHAVIORAL HEALTH
ID000010154305OtherREGENCE BLUE SHIELD OF ID