Organization
SEASONS OF HOPE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATH JACOB SOMMER PH.D. (CEO)
(208) 237-9833
Entity
Organization
Contact information
Practice address
4650 HAWTHORNE RD, SUITE 3B, CHUBBUCK, ID 83202-2376
(208) 237-9833
(208) 237-1800
Mailing address
4650 HAWTHORNE RD, SUITE 3B, CHUBBUCK, ID 83202-2376
(208) 237-9833
(208) 237-1800
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-27911
ID
225X00000X
Occupational Therapist
OT-807
ID
235Z00000X
Speech-Language Pathologist
SLP-1893
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376865006
—
ID
Enumeration date
07/27/2010
Last updated
07/27/2010
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