Healthcare Provider Details

I. General information

NPI: 1922490440
Provider Name (Legal Business Name): HAILEY HOLLAND LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1566 SUMMIT CIR
IDAHO FALLS ID
83402-2605
US

IV. Provider business mailing address

1566 SUMMIT CIR
IDAHO FALLS ID
83402-2605
US

V. Phone/Fax

Practice location:
  • Phone: 208-403-9731
  • Fax:
Mailing address:
  • Phone: 208-403-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-44458
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: