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NPI Code Detail

MEDICARE: MRS. KRISTINE E KENDALL L.C.S.W.

MEDICARE: MRS. KRISTINE E KENDALL L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW-902ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000010015713OTHERIDREGENCE BLUE SHIELD
2L9123OTHERIDBLUE CROSS OF IDAHO

General Provider Information

NPI Number : 1285768705
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTINE E KENDALL L.C.S.W.
Provider Business Mailing Address
First Line : 817 E HIGHLAND VIEW DR
Second Line :
City : BOISE
State : ID
Zip : 83702-1928
Country : US
Telephone Number : 208-371-1959
Fax Number :
Provider Business Practice Location Address
First Line : 740 WARM SPRINGS AVE
Second Line :
City : BOISE
State : ID
Zip : 83712-6420
Country : US
Telephone Number : 208-343-7797
Fax Number : 208-343-0064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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