Healthcare Provider Details

I. General information

NPI: 1720994197
Provider Name (Legal Business Name): STEFANIE HAZARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E SELTICE WAY
POST FALLS ID
83854-7007
US

IV. Provider business mailing address

3349 N CORVUS ST
POST FALLS ID
83854-3811
US

V. Phone/Fax

Practice location:
  • Phone: 208-719-7158
  • Fax:
Mailing address:
  • Phone: 682-229-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7271994
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: