Healthcare Provider Details

I. General information

NPI: 1922928886
Provider Name (Legal Business Name): STEPHEN AYDELOTTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15295 ROSEMAN WAY
CALDWELL ID
83607-5785
US

IV. Provider business mailing address

15295 ROSEMAN WAY
CALDWELL ID
83607-5785
US

V. Phone/Fax

Practice location:
  • Phone: 208-680-3281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: