MEDICARE: KAYLA FRODSHAM

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
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	103TC0700X	Clinical Psychologist	SE-203754	ID

General Provider Information

NPI Number	:	1679939052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA FRODSHAM

Provider Business Mailing Address
First Line	:	3753 N NORTH ST # H-302
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6523
Country	:	US
Telephone Number	:	208-890-6917
Fax Number	:

Provider Business Practice Location Address
First Line	:	3753 N NORTH ST APT H-302
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6523
Country	:	US
Telephone Number	:	208-890-6917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	01/30/2023

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Directions to “ KAYLA FRODSHAM ” Practice Location

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