Provider Demographics
NPI:1215521646
Name:HYATT, SAUSHA NICHOLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:SAUSHA
Middle Name:NICHOLE
Last Name:HYATT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11288 W BODIE RIVER LOOP
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5631
Mailing Address - Country:US
Mailing Address - Phone:208-250-7711
Mailing Address - Fax:
Practice Address - Street 1:123 N YALE ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-2340
Practice Address - Country:US
Practice Address - Phone:208-585-3375
Practice Address - Fax:208-585-6152
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health