Healthcare Provider Details

I. General information

NPI: 1063327203
Provider Name (Legal Business Name): KELLY GARRETT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 N GOVERNMENT WAY
COEUR D ALENE ID
83814-3446
US

IV. Provider business mailing address

260 W PATIENCE AVE APT 101
COEUR D ALENE ID
83815-1016
US

V. Phone/Fax

Practice location:
  • Phone: 208-797-1162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number43179
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: