Provider Demographics
NPI:1861152548
Name:HEGLER, BANY
Entity type:Individual
Prefix:
First Name:BANY
Middle Name:
Last Name:HEGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BANY
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:3040 N FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5234
Mailing Address - Country:US
Mailing Address - Phone:208-376-4999
Mailing Address - Fax:208-376-4988
Practice Address - Street 1:1998 8TH ST N.
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-8364
Practice Address - Country:US
Practice Address - Phone:208-587-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-414871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical