Healthcare Provider Details

I. General information

NPI: 1770052821
Provider Name (Legal Business Name): MARGARET J HEDELIUS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNE HEDELIUS LCPC

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 12TH AVE S STE 201
NAMPA ID
83651-3952
US

IV. Provider business mailing address

17 12TH AVE S STE 201
NAMPA ID
83651-3952
US

V. Phone/Fax

Practice location:
  • Phone: 208-570-7234
  • Fax: 208-965-2052
Mailing address:
  • Phone: 208-570-7234
  • Fax: 208-965-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8776
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-6897
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: