Provider Demographics
NPI:1245115765
Name:RIZO GONZALEZ, JAZMIN (LMSW)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:RIZO GONZALEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LAUDER AVE
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4407
Mailing Address - Country:US
Mailing Address - Phone:509-521-1832
Mailing Address - Fax:
Practice Address - Street 1:305 LAUDER AVE
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4407
Practice Address - Country:US
Practice Address - Phone:509-521-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8977964104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker