MEDICARE: DR. ELIZABETH ANN LIST PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY-202790	ID

General Provider Information

NPI Number	:	1205055613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANN LIST PSYD

Provider Business Mailing Address
First Line	:	623 S UNIVERSITY BLVD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5800
Country	:	US
Telephone Number	:	503-758-2881
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 E AMITY AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-1053
Country	:	US
Telephone Number	:	208-467-8428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	04/02/2025

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