MEDICARE: HAYLEY STODDART BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		ID

General Provider Information

NPI Number	:	1154284685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEY STODDART BS

Provider Business Mailing Address
First Line	:	3713 DELOY DR APT 2
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-1944
Country	:	US
Telephone Number	:	208-612-5035
Fax Number	:	208-612-5036

Provider Business Practice Location Address
First Line	:	3713 DELOY DR APT 2
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-1944
Country	:	US
Telephone Number	:	208-612-5035
Fax Number	:	208-612-5036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ HAYLEY STODDART BS” Practice Location

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