Provider Demographics
NPI:1548775232
Name:GARDNER-GOULD, CASSIE MIKAILA
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:MIKAILA
Last Name:GARDNER-GOULD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5035
Mailing Address - Country:US
Mailing Address - Phone:763-639-8571
Mailing Address - Fax:
Practice Address - Street 1:8660 W EMERALD ST STE 112
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4829
Practice Address - Country:US
Practice Address - Phone:208-391-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6971772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker