Healthcare Provider Details

I. General information

NPI: 1912286618
Provider Name (Legal Business Name): CHELSEY JO HALE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CHELSEY JO OLSEN

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 W BROADWAY ST STE G
IDAHO FALLS ID
83402-2902
US

IV. Provider business mailing address

1330 RICHLAND DR
IDAHO FALLS ID
83401-4089
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-7400
  • Fax:
Mailing address:
  • Phone: 208-521-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-41038
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: