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General NPI Number Information
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NPI Number | 1770009854
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Entity Type | Individual
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Provider Name | KATHLEEN VICTORIA PODUSKA LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2017
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 502 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5298
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Country | US
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Telephone | 208-346-7500
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Fax | 208-346-7501
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Provider Business Mailing Address
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Address Line | 4159 LOWELL BLVD
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City | DENVER
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State | CO
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Zip | 80211-1658
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Country | US
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Telephone |
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-LCPC-LIC-23176
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0014263
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-8421
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License Number State | ID
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