Healthcare Provider Details

I. General information

NPI: 1124131347
Provider Name (Legal Business Name): MARGARET CATHERINE GWIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 KOOTENAI ST
BOISE ID
83705-2326
US

IV. Provider business mailing address

2901 KOOTENAI ST
BOISE ID
83705-2326
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-4855
  • Fax: 208-343-4856
Mailing address:
  • Phone: 208-343-4855
  • Fax: 208-343-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY202202
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1193
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: