Healthcare Provider Details

I. General information

NPI: 1821891441
Provider Name (Legal Business Name): MADISON HATHAWAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W ST LUKES DR
NAMPA ID
83687-7912
US

IV. Provider business mailing address

9850 W ST LUKES DR
NAMPA ID
83687-7912
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-2021
  • Fax:
Mailing address:
  • Phone: 208-505-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9961466
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: