Individual provider Active NPI

Brooke Herzog, LCSW

  • Clinical Social Worker
  • Meridian, ID
National Provider Identifier
1629402888
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-37178 Issued in ID
Practice address
520 S Eagle Rd Ste 1229
Meridian, ID 83642-6355
Phone
(208) 331-1155
Fax
(208) 383-0190
NPI assigned
Aug 23, 2013
Last updated
May 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 33040 ID
Clinical Social Worker 1041C0700X LCSW-37178 ID Primary

Addresses

Primary practice location

520 S Eagle Rd Ste 1229
Meridian, ID 83642-6355

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other practice location 1

915 Parkcentre Way
Suite 7
Nampa, ID 83651-1745
Phone (208) 442-7791

Other practice location 2

3277 E Louise Dr Ste 220
Meridian, ID 83642-9390
Phone (208) 514-2509

Other practice location 3

925 NW 1st St
Meridian, ID 83642
Phone (208) 514-2527

Other identifiers 1

IdentifierTypeStateIssuer
1629402888MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180404001985 ID Practitioner - Clinical Social Worker 1557624590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

1226 W River St
Boise, ID 83702-7049
Phone (208) 331-1155

520 S Eagle Rd
Meridian, ID 83642-6355

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33040IDMDSocial Worker
LCSW-37178IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince May 23, 2025 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince May 23, 2025 Accepting new patients
St Lukes Regional Medical Center PastSince May 25, 2025 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

520 S Eagle Rd
Ste 1229
Meridian, ID 83642
Phone (208) 331-1155

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1629402888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S EAGLE RD STE 1229",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426355",
            "telephone_number": "208-331-1155",
            "fax_number": "208-383-0190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "915 Parkcentre Way",
            "address_2": "Suite 7",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836511745",
            "country_code": "US",
            "telephone_number": "208-442-7791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3277 E Louise Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836429390",
            "country_code": "US",
            "telephone_number": "208-514-2509",
            "fax_number": "208-375-2217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "925 NW 1st St",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "83642",
            "country_code": "US",
            "telephone_number": "208-514-2527",
            "fax_number": "208-375-2217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "BROOKE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-23",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "33040",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-37178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629402888",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.