Provider Demographics
NPI:1316042799
Name:HAUSER, STEPHANIE L (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:HAUSER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 W FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1042
Mailing Address - Country:US
Mailing Address - Phone:208-949-3056
Mailing Address - Fax:
Practice Address - Street 1:6203 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1042
Practice Address - Country:US
Practice Address - Phone:208-949-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3764101YP2500X
ID4209101YP2500X
MN00276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43705400Medicaid