=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619158979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE HADLEY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2007
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4750 N FIVE MILE RD
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83713-2715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-949-4864
-----------------------------------------------------
Fax | 208-939-9110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3725 W 4100 S STE 201
-----------------------------------------------------
City | WEST VALLEY CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84120-6490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-949-4864
-----------------------------------------------------
Fax | 208-939-9110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 28120
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------