Individual
ERIC J FIELDSTAD II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5185 W OVERLAND RD, BOISE, ID 83705-2635
(208) 918-0697
(208) 342-7584
Mailing address
PO BOX 45581, BOISE, ID 83711-5581
(208) 880-3837
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-34845
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-38192
ID
1041S0200X
School Social Worker
LMSW-34845
ID
Other
Enumeration date
03/22/2016
Last updated
02/08/2023
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