Provider Demographics
NPI:1144387598
Name:HOADLEY, FREDERICK EDWARD (D MIN)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:EDWARD
Last Name:HOADLEY
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 S SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-3108
Mailing Address - Country:US
Mailing Address - Phone:208-442-6464
Mailing Address - Fax:
Practice Address - Street 1:4444 W TAFT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-4148
Practice Address - Country:US
Practice Address - Phone:208-344-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT - 3266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist