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NPI Code Detail

MEDICARE: ERIC J FIELDSTAD II LCSW

MEDICARE: ERIC J FIELDSTAD II LCSW
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
1104100000XSocial WorkerLMSW-34845ID
21041S0200XSchool Social WorkerLMSW-34845ID
31041C0700XClinical Social WorkerLCSW-38192ID

General Provider Information

NPI Number : 1194187898
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC J FIELDSTAD II LCSW
Provider Business Mailing Address
First Line : PO BOX 45581
Second Line :
City : BOISE
State : ID
Zip : 83711-5581
Country : US
Telephone Number : 208-880-3837
Fax Number :
Provider Business Practice Location Address
First Line : 5185 W OVERLAND RD
Second Line :
City : BOISE
State : ID
Zip : 83705-2635
Country : US
Telephone Number : 208-918-0697
Fax Number : 208-342-7584
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2016
Last Update Date : 02/08/2023

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