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General NPI Number Information
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NPI Number | 1760284426
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Entity Type | Organization
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Legal Business Name | THERASENSE, LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1069 SUMMERS DR STE B
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City | REXBURG
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State | ID
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Zip | 83440-5335
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Country | US
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Telephone | 208-557-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 330 N 2300 E
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City | SAINT ANTHONY
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State | ID
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Zip | 83445-5616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY STIMPSON
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Credential | LCSW
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Telephone | 208-557-3430
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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 |
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License Number State |
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