Healthcare Provider Details

I. General information

NPI: 1689227878
Provider Name (Legal Business Name): HEIDI LYNN ROGERS LCSW, ACADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 PARKCENTRE WAY STE 3
NAMPA ID
83651-1794
US

IV. Provider business mailing address

6701 AIRPORT RD
NAMPA ID
83687-8656
US

V. Phone/Fax

Practice location:
  • Phone: 208-901-8192
  • Fax:
Mailing address:
  • Phone: 208-249-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8911164
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5085
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13033
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: