Individual
SHAUNA LYNN STAUFENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
963 S ORCHARD ST STE 103, BOISE, ID 83705-1917
(208) 794-1134
(208) 342-1696
Mailing address
312 9TH AVE N, NAMPA, ID 83687-3344
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-43071
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9630
—
ID
Enumeration date
03/02/2023
Last updated
03/02/2023
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