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General NPI Number Information
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NPI Number | 1992997837
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE MICHAUD PHD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 5995 W STATE ST STE A
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City | GARDEN CITY
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State | ID
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Zip | 83703-3085
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Country | US
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Telephone | 208-985-3340
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Fax | 208-629-1358
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Provider Business Mailing Address
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Address Line | PO BOX 140544
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City | GARDEN CITY
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State | ID
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Zip | 83714-0544
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Country | US
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Telephone | 208-985-3340
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Fax | 208-629-1358
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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 | 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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