Healthcare Provider Details

I. General information

NPI: 1265216352
Provider Name (Legal Business Name): SAMANTHA ANGELIQUE SAVAGE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 16TH AVE N
NAMPA ID
83687-4058
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-7654
  • Fax: 208-466-5359
Mailing address:
  • Phone: 208-461-7149
  • Fax: 208-467-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-43766
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: