Provider Demographics
NPI:1861140477
Name:BUNKER, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BUNKER
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 1:1126 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2195
Mailing Address - Country:US
Mailing Address - Phone:208-329-4870
Mailing Address - Fax:
Practice Address - Street 1:425 S WHITLEY DR STE 2
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2681
Practice Address - Country:US
Practice Address - Phone:208-230-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMSW-42654104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker