Individual
VIRGINIA PAGE HAVILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
4424 E FLAMINGO AVE STE 310, NAMPA, ID 83687-9306
(208) 302-3760
(208) 302-3768
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY 292
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010153284
REGENCE BLUE SHIELD OF ID
ID
01
—
203644829
TAX I.D. NUMBER
ID
01
—
76372
BLUE CROSS OF IDAHO
ID
Enumeration date
08/07/2006
Last updated
01/04/2022
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