Provider Demographics
NPI:1811543994
Name:NEBEKER, SADIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:J
Last Name:NEBEKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:J
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 FERN ST.
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:435-760-3819
Mailing Address - Fax:208-906-0998
Practice Address - Street 1:28371 EL PASO RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-7521
Practice Address - Country:US
Practice Address - Phone:208-454-8847
Practice Address - Fax:208-454-9014
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9334417-35021041C0700X
IDLMSW-389491041C0700X
IDLCSW-429391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical