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General NPI Number Information
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NPI Number | 1194617845
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Entity Type | Individual
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Provider Name | SHEYENNE DAWN HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 1248 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6126
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Country | US
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Telephone | 208-542-1026
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Fax |
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Provider Business Mailing Address
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Address Line | 69 N 900 W
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City | BLACKFOOT
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State | ID
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Zip | 83221-5390
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Country | US
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Telephone | 208-681-3013
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | LSW-31953
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW45186
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License Number State | ID
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