Provider Demographics
NPI:1902611692
Name:RILEY, HEATHER (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RILEY
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 1:2217 S MANITOU AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-4152
Mailing Address - Country:US
Mailing Address - Phone:206-218-8045
Mailing Address - Fax:
Practice Address - Street 1:515 S VISTA AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1710
Practice Address - Country:US
Practice Address - Phone:206-218-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602060481041C0700X
ID36711351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical