Healthcare Provider Details

I. General information

NPI: 1184160970
Provider Name (Legal Business Name): BRANDI HOBBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 FREMONT AVE
IDAHO FALLS ID
83402-1510
US

IV. Provider business mailing address

1955 FREMONT AVE
IDAHO FALLS ID
83402-1510
US

V. Phone/Fax

Practice location:
  • Phone: 208-526-0218
  • Fax:
Mailing address:
  • Phone: 208-526-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number36202
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number38439
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: