Healthcare Provider Details

I. General information

NPI: 1871369405
Provider Name (Legal Business Name): SYDNIE BALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 E AMITY AVE STE 106
NAMPA ID
83687-1194
US

IV. Provider business mailing address

1709 DEARBORN ST
CALDWELL ID
83605-5040
US

V. Phone/Fax

Practice location:
  • Phone: 208-614-1899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: