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NPI Code Detail

MEDICARE: KIMBERLY ANN STOCKWELL

MEDICARE: KIMBERLY ANN STOCKWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC-6699ID

General Provider Information

NPI Number : 1396277000
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANN STOCKWELL
Provider Business Mailing Address
First Line : 524 S 9TH AVE STE 103
Second Line :
City : CALDWELL
State : ID
Zip : 83605-5072
Country : US
Telephone Number : 208-454-2144
Fax Number : 208-454-2149
Provider Business Practice Location Address
First Line : 524 S 9TH AVE STE 103
Second Line :
City : CALDWELL
State : ID
Zip : 83605-5072
Country : US
Telephone Number : 208-454-2144
Fax Number : 208-454-2149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2017
Last Update Date : 10/09/2017

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Directions to “ KIMBERLY ANN STOCKWELL ” Practice Location

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