Healthcare Provider Details

I. General information

NPI: 1750227922
Provider Name (Legal Business Name): SOARING FREE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 CARRIAGE LN N
TWIN FALLS ID
83301-7589
US

IV. Provider business mailing address

3301 43RD AVE S
FARGO ND
58104-6638
US

V. Phone/Fax

Practice location:
  • Phone: 541-778-5656
  • Fax:
Mailing address:
  • Phone: 541-778-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNA BREHM-GIBSON
Title or Position: LCSW
Credential:
Phone: 541-778-5656