Healthcare Provider Details

I. General information

NPI: 1306769310
Provider Name (Legal Business Name): KAITLYN MARIE VANDYK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN MARIE HARNESS LMSW

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S COLE RD
BOISE ID
83709-0932
US

IV. Provider business mailing address

3918 W TORANA DR
MERIDIAN ID
83646-1263
US

V. Phone/Fax

Practice location:
  • Phone: 208-683-8320
  • Fax: 208-969-8380
Mailing address:
  • Phone: 208-749-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7381311
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7381311
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: