Healthcare Provider Details

I. General information

NPI: 1750142303
Provider Name (Legal Business Name): BAILEY ADELAIDE SPRATLING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 SHOUP AVE STE 205
IDAHO FALLS ID
83402-3658
US

IV. Provider business mailing address

1379 E 17TH ST
IDAHO FALLS ID
83404-6235
US

V. Phone/Fax

Practice location:
  • Phone: 208-881-7786
  • Fax:
Mailing address:
  • Phone: 208-497-2781
  • Fax: 208-904-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8911525
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: