Healthcare Provider Details

I. General information

NPI: 1215521646
Provider Name (Legal Business Name): SAUSHA NICHOLE HYATT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 GRANT ST
CALDWELL ID
83605-4137
US

IV. Provider business mailing address

1917 E LOCUST ST
CALDWELL ID
83605-5940
US

V. Phone/Fax

Practice location:
  • Phone: 208-585-3375
  • Fax: 208-585-6152
Mailing address:
  • Phone: 208-250-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861643
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: