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General NPI Number Information
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NPI Number | 1063389773
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Entity Type | Individual
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Provider Name | STEPHANIE KUNKEL SLOAN
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Gender | Female
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 10270 S 2000 W
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City | VICTOR
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State | ID
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Zip | 83455-5269
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Country | US
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Telephone | 307-760-8379
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Fax |
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Provider Business Mailing Address
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Address Line | 10270 S 2000 W
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City | VICTOR
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State | ID
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Zip | 83455-5269
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Country | US
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Telephone | 307-760-8379
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PPC-1451
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License Number State | WY
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