Healthcare Provider Details

I. General information

NPI: 1073422275
Provider Name (Legal Business Name): JAIME CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 LARKSPUR ST
PONDERAY ID
83852-5011
US

IV. Provider business mailing address

207 LARKSPUR ST
PONDERAY ID
83852-5011
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-9840
  • Fax:
Mailing address:
  • Phone: 208-263-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: