Individual
STEPHANIE LYNN WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
9196 W BARNES DR, BOISE, ID 83709-1552
(208) 433-0400
(208) 433-5271
Mailing address
9196 W BARNES DR, BOISE, ID 83709-1552
(208) 433-0400
(208) 433-5271
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1094
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1094
CADC
ID
05
—
1094
—
ID
Enumeration date
02/11/2020
Last updated
02/11/2020
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