Healthcare Provider Details

I. General information

NPI: 1013313667
Provider Name (Legal Business Name): KATHERINE ANN TROUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 6TH AVE
LEWISTON ID
83501-2355
US

IV. Provider business mailing address

900 7TH ST
CLARKSTON WA
99403-2005
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-6500
  • Fax: 208-799-6504
Mailing address:
  • Phone: 509-758-3341
  • Fax: 509-769-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-31455
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-39564
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: