Healthcare Provider Details

I. General information

NPI: 1700710696
Provider Name (Legal Business Name): JESSICA STALEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 N COLE RD STE 150
BOISE ID
83704-5965
US

IV. Provider business mailing address

6317 W MARVIN ST
BOISE ID
83709-2138
US

V. Phone/Fax

Practice location:
  • Phone: 208-703-7357
  • Fax: 208-712-6778
Mailing address:
  • Phone: 208-890-3284
  • Fax: 208-890-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: