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NPI Code Detail

MEDICARE: MISS KENDRA J WESTERHAUS M.S.

MEDICARE: MISS KENDRA J WESTERHAUS M.S.
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
1103TC2200XClinical Child & Adolescent Psychologist

General Provider Information

NPI Number : 1366750929
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KENDRA J WESTERHAUS M.S.
Provider Business Mailing Address
First Line : 500 S 11TH AVE STE 400
Second Line :
City : POCATELLO
State : ID
Zip : 83201-4880
Country : US
Telephone Number : 208-232-7862
Fax Number : 208-232-2408
Provider Business Practice Location Address
First Line : 500 S 11TH AVE STE 204
Second Line :
City : POCATELLO
State : ID
Zip : 83201-4878
Country : US
Telephone Number : 208-232-7862
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2010
Last Update Date : 04/23/2019

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