Healthcare Provider Details

I. General information

NPI: 1942123773
Provider Name (Legal Business Name): KOLODGE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N SAGEHEN LN
NAMPA ID
83651-5055
US

IV. Provider business mailing address

40 N SAGEHEN LN
NAMPA ID
83651-5055
US

V. Phone/Fax

Practice location:
  • Phone: 208-241-4728
  • Fax:
Mailing address:
  • Phone: 208-241-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE HILLMAN
Title or Position: OWNER
Credential: LSW, BCBA
Phone: 208-241-4728