Individual
MADISON HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
685 1ST ST, IDAHO FALLS, ID 83401-4003
(208) 881-0070
Mailing address
685 1ST ST, IDAHO FALLS, ID 83401-4003
(208) 881-0070
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
ID
Other
Enumeration date
03/29/2025
Last updated
03/29/2025
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