Healthcare Provider Details

I. General information

NPI: 1093467276
Provider Name (Legal Business Name): HEATHER HAYNES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ADAMS

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W HEMINGWAY BLVD
NAMPA ID
83651-1763
US

IV. Provider business mailing address

3559 S CENTENNIAL WAY
BOISE ID
83706-5609
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-9990
  • Fax:
Mailing address:
  • Phone: 509-599-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861407
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: