=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154060952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATELYN MCKIRGAN LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2022
-----------------------------------------------------
Last Update Date | 12/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1312 S WASHINGTON AVE STE 3
-----------------------------------------------------
City | EMMETT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83617-3573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-481-4461
-----------------------------------------------------
Fax | 208-369-4191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1312 S WASHINGTON AVE STE 3
-----------------------------------------------------
City | EMMETT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83617-3573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-481-4461
-----------------------------------------------------
Fax | 208-369-4191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 8911033
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------