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General NPI Number Information
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NPI Number | 1578034690
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Entity Type | Individual
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Provider Name | ALEXIS STAEB LMSW, CCLS, CFLE
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Gender | Female
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 3023 E COPPER POINT DR STE 105
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City | MERIDIAN
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State | ID
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Zip | 83642-9290
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Country | US
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Telephone | 208-606-4176
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Fax |
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Provider Business Mailing Address
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Address Line | 6217 W YORK ST
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City | BOISE
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State | ID
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Zip | 83704-7571
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Country | US
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Telephone | 208-360-7315
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-38122
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License Number State | ID
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