Healthcare Provider Details

I. General information

NPI: 1467380154
Provider Name (Legal Business Name): AUDRA LOU GABICA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W SUPERIOR ST
SANDPOINT ID
83864-1619
US

IV. Provider business mailing address

424 W SUPERIOR ST
SANDPOINT ID
83864-1619
US

V. Phone/Fax

Practice location:
  • Phone: 208-290-3435
  • Fax: 208-290-3435
Mailing address:
  • Phone: 208-290-3435
  • Fax: 208-290-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: