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General NPI Number Information
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NPI Number | 1427599885
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Entity Type | Organization
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Legal Business Name | KATHLEEN MICHAUD PHD LLC
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 2498 N STOKESBERRY PL SUITE 140
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City | MERIDIAN
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State | ID
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Zip | 83646-5150
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Country | US
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Telephone | 208-971-5806
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Fax | 208-629-1358
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Provider Business Mailing Address
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Address Line | 2498 N STOKESBERRY PL SUITE 140
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City | MERIDIAN
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State | ID
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Zip | 83646-5150
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Country | US
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Telephone | 208-971-5806
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Fax | 208-629-1358
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Authorized Official
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Title or Position | CLINCIAL PSYCOLOGIIST, SOLE MBR
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Name | DR. KATHLEEN M MICHAUD
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Credential | PHD
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Telephone | 208-971-5806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY202738
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License Number State | ID
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