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General NPI Number Information
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NPI Number | 1154476182
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Entity Type | Individual
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Provider Name | LETA M NEUSTAEDTER LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 511 W MAIN ST
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City | BOISE
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State | ID
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Zip | 83702-5933
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Country | US
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Telephone | 208-697-4703
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Fax |
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Provider Business Mailing Address
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Address Line | 715 E SHERMAN AVE
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City | NAMPA
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State | ID
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Zip | 83686-5247
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Country | US
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Telephone | 208-697-4703
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-28520
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License Number State | ID
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