Provider Demographics
NPI:1629828173
Name:ROCHE, KIRSTEN (LMSW, BS, CPSS)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:ROCHE
Suffix:
Gender:F
Credentials:LMSW, BS, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 W OVERLAND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3075
Mailing Address - Country:US
Mailing Address - Phone:208-417-8428
Mailing Address - Fax:
Practice Address - Street 1:6305 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3029
Practice Address - Country:US
Practice Address - Phone:208-605-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
ID81718691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker