1831362821 NPI number — MS. STEPHANIE B HATZENBUEHLER LCSW

Table of content: MS. STEPHANIE B HATZENBUEHLER LCSW (NPI 1831362821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831362821 NPI number — MS. STEPHANIE B HATZENBUEHLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATZENBUEHLER
Provider First Name:
STEPHANIE
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831362821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAILEY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-922-7064
Provider Business Mailing Address Fax Number:
208-928-7647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 N MAIN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
KETCHUM
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-922-7064
Provider Business Practice Location Address Fax Number:
208-928-7647
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-37119 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com