Individual
KATHLEEN WINDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, MSW
Contact information
Practice address
5985 W STATE ST, BOISE, ID 83703-3039
(208) 853-0071
(208) 853-9422
Mailing address
5985 W STATE ST, BOISE, ID 83703-3039
(208) 853-0071
(208) 853-9422
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW24628
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW-24628
LICENSE
ID
Enumeration date
11/06/2019
Last updated
11/06/2019
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