Provider Demographics
NPI:1770052821
Name:HEDELIUS, MARGARET J (LCPC)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:J
Last Name:HEDELIUS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:HEDELIUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:17 12TH AVE S STE 201
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3952
Mailing Address - Country:US
Mailing Address - Phone:208-570-7234
Mailing Address - Fax:208-965-2052
Practice Address - Street 1:17 12TH AVE S STE 201
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3952
Practice Address - Country:US
Practice Address - Phone:208-570-7234
Practice Address - Fax:208-965-2052
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6897101YP2500X
ID8776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional