Healthcare Provider Details

I. General information

NPI: 1396693206
Provider Name (Legal Business Name): KAITLYN ROSE KOONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 E 4TH AVE
POST FALLS ID
83854-4096
US

IV. Provider business mailing address

71 BETTY MAE WAY
NEWPORT WA
99156-9470
US

V. Phone/Fax

Practice location:
  • Phone: 208-723-9474
  • Fax:
Mailing address:
  • Phone: 434-534-1499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: