Healthcare Provider Details

I. General information

NPI: 1639007131
Provider Name (Legal Business Name): HILLARY ROSE WARDELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 E 4TH N STE 231
REXBURG ID
83440-6009
US

IV. Provider business mailing address

20 N MILLHOLLOW RD
REXBURG ID
83440-1647
US

V. Phone/Fax

Practice location:
  • Phone: 208-261-2131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8081618
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: