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General NPI Number Information
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NPI Number | 1770206674
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Entity Type | Individual
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Provider Name | WYATT LYNN HAYES LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1309 CAMAS ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-3060
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Country | US
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Telephone | 208-782-0675
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N 700 W
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City | BLACKFOOT
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State | ID
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Zip | 83221-5311
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Country | US
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Telephone | 208-681-6916
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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 | 38471
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License Number State | ID
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