Individual
DIANE HAKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
315 N ALLUMBAUGH ST, BOISE, ID 83704-9208
(208) 376-3546
(208) 376-9792
Mailing address
4877 LAKES EDGE PL, BOISE, ID 83714-1951
(208) 954-2871
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-24943
ID
Other
Enumeration date
04/15/2014
Last updated
08/07/2015
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