Provider Demographics
NPI:1538448055
Name:RUGGIERO-BODDEN, STEPHANIE LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:RUGGIERO-BODDEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:BODDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:SUITE 444
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1803
Mailing Address - Country:US
Mailing Address - Phone:208-750-3000
Mailing Address - Fax:208-750-1244
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:SUITE 444
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1803
Practice Address - Country:US
Practice Address - Phone:208-750-3000
Practice Address - Fax:208-750-1244
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health