Healthcare Provider Details

I. General information

NPI: 1235850538
Provider Name (Legal Business Name): KATIE S HAYS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE PETERSON

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N RAIL ST W
SHOSHONE ID
83352-5173
US

IV. Provider business mailing address

606 N RAIL ST W
SHOSHONE ID
83352-5173
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-9286
  • Fax:
Mailing address:
  • Phone: 208-201-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-8911131
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: