Stephanie B Hatzenbuehler, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-37119 Issued in ID

Practice address

660 N Main St
2ND Floor
Ketchum, ID 83340

Phone

(208) 922-7064

Fax

(208) 928-7647

NPI assigned

Apr 10, 2008

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 28, 2020.

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1831362821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3387",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "83333",
            "telephone_number": "208-922-7064",
            "fax_number": "208-928-7647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 N MAIN ST",
            "address_2": "2ND FLOOR",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-922-7064",
            "fax_number": "208-928-7647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATZENBUEHLER",
        "first_name": "STEPHANIE",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-10",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-37119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abram Joseph Guard, PHARMD
• Kathleen Egan Haisley, MD
• Rio Hale
• Robert Winston Hall, M.D.
• Christine Hansen
• Jane Ellen Henley, LMFT
• Randall T Hermann, MD
• James Walter Hodge, D.D.S.
• Gary Franklin Hoffman, M.D.
• Jon J Holmquist

• All providers in Ketchum, ID
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.