Provider Demographics
NPI:1285062109
Name:STELLWAY, JANET NAOMI (LMSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:NAOMI
Last Name:STELLWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5014
Mailing Address - Country:US
Mailing Address - Phone:208-463-0212
Mailing Address - Fax:208-461-5452
Practice Address - Street 1:323 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5014
Practice Address - Country:US
Practice Address - Phone:208-463-0212
Practice Address - Fax:208-461-5452
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW30500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker