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General NPI Number Information
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NPI Number | 1871807354
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Entity Type | Organization
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Legal Business Name | SEASONS OF HOPE, LLC
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 4650 HAWTHORNE RD SUITE 3B
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City | CHUBBUCK
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State | ID
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Zip | 83202-2376
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Country | US
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Telephone | 208-237-9833
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Fax | 208-237-1800
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Provider Business Mailing Address
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Address Line | 4650 HAWTHORNE RD SUITE 3B
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City | CHUBBUCK
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State | ID
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Zip | 83202-2376
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Country | US
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Telephone | 208-237-9833
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Fax | 208-237-1800
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Authorized Official
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Title or Position | CEO
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Name | HEATH JACOB SOMMER
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Credential | PH.D.
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Telephone | 208-237-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-807
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP-1893
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-27911
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License Number State | ID
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