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General NPI Number Information
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NPI Number | 1164543666
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Entity Type | Individual
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Provider Name | KATHY LYNN KWIATKOWSKI LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 814 S WASHINGTON ST
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City | MOSCOW
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State | ID
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Zip | 83843-3049
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Country | US
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Telephone | 208-883-0619
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Fax | 208-882-4774
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Provider Business Mailing Address
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Address Line | 455 MOSER CT
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City | MOSCOW
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State | ID
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Zip | 83843-9598
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Country | US
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Telephone | 208-883-0619
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Fax | 208-882-4774
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2741
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5239
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License Number State | WA
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