Healthcare Provider Details

I. General information

NPI: 1649019274
Provider Name (Legal Business Name): ALEXANDRIA FELDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S ALLUMBAUGH WAY
BOISE ID
83709-5658
US

IV. Provider business mailing address

PO BOX 1494
MERIDIAN ID
83680-1494
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-8888
  • Fax: 208-323-8889
Mailing address:
  • Phone: 208-323-8888
  • Fax: 208-323-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-10534
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: