Healthcare Provider Details

I. General information

NPI: 1265975650
Provider Name (Legal Business Name): VICTORIA WHITE EAGLE HAHN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W 3RD ST
MOSCOW ID
83843-2204
US

IV. Provider business mailing address

325 W 3RD ST
MOSCOW ID
83843-2204
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2566
  • Fax:
Mailing address:
  • Phone: 208-882-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-40439
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: