Healthcare Provider Details

I. General information

NPI: 1316042799
Provider Name (Legal Business Name): STEPHANIE L HAUSER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 W FRANKLIN RD
BOISE ID
83709-1042
US

IV. Provider business mailing address

6203 W FRANKLIN RD
BOISE ID
83709-1042
US

V. Phone/Fax

Practice location:
  • Phone: 208-949-3056
  • Fax:
Mailing address:
  • Phone: 208-949-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3764
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4209
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00276
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: