Healthcare Provider Details

I. General information

NPI: 1699345579
Provider Name (Legal Business Name): HEATHER CROFT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 CURLEW DR
AMMON ID
83406-4850
US

IV. Provider business mailing address

429 6TH ST
IDAHO FALLS ID
83401-4708
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-5319
  • Fax: 208-523-5627
Mailing address:
  • Phone: 208-557-8180
  • Fax: 855-582-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861600
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: