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General NPI Number Information
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NPI Number | 1679379531
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Entity Type | Individual
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Provider Name | EMILY HACKWORTH
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Gender |
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 343 E 4TH N STE 227
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City | REXBURG
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State | ID
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Zip | 83440-6008
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Country | US
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Telephone | 208-208-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 833 SAGE DR
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City | SAINT ANTHONY
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State | ID
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Zip | 83445-5417
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Country | US
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Telephone | 208-351-4980
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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 | 7371149
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License Number State | ID
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