Provider Demographics
NPI:1972237311
Name:COTNER, REBEKAH LYNN KETURAH (MSW, LSWAIC/LCSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN KETURAH
Last Name:COTNER
Suffix:
Gender:F
Credentials:MSW, LSWAIC/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 S FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2325
Mailing Address - Country:US
Mailing Address - Phone:208-254-1027
Mailing Address - Fax:
Practice Address - Street 1:2273 S VISTA AVE STE 190
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-7341
Practice Address - Country:US
Practice Address - Phone:208-343-2737
Practice Address - Fax:208-342-3238
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA615239601041C0700X
IDLCSW-453711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61213148Medicaid