MEDICARE: MRS. CHELSEY JO HALE LMSW

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	104100000X	Social Worker	LMSW-41038	ID

General Provider Information

NPI Number	:	1912286618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHELSEY JO HALE LMSW

Provider Business Mailing Address
First Line	:	1330 RICHLAND DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-4089
Country	:	US
Telephone Number	:	208-521-5755
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 W BROADWAY ST STE G
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-2902
Country	:	US
Telephone Number	:	208-524-7400
Fax Number	:

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

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	02/21/2022

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