Healthcare Provider Details

I. General information

NPI: 1013582501
Provider Name (Legal Business Name): STORMY M KLEFFNER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STORMY M COLLINS AU.D.

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E STATE ST STE 100
EAGLE ID
83616-7499
US

IV. Provider business mailing address

440 E STATE ST STE 100
EAGLE ID
83616-7499
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-9359
  • Fax:
Mailing address:
  • Phone: 208-939-9359
  • Fax: 208-939-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD-4741
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-4741
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: