=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043106065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON JEAN HOBDY LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2025
-----------------------------------------------------
Last Update Date | 06/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3676 N HARBOR LN STE 100
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83703-6919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-607-3505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 E RIVER VALLEY ST APT K205
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83646-2364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-629-7836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 1271160
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------