Healthcare Provider Details

I. General information

NPI: 1508336900
Provider Name (Legal Business Name): STEFANI LYNNE CAMPA-MACFEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 N COLLEGE RD STE D
TWIN FALLS ID
83301-3486
US

IV. Provider business mailing address

829 NEBRASKA ST
GOODING ID
83330-1634
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-9100
  • Fax:
Mailing address:
  • Phone: 208-308-8934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-39465
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: