Individual
AUTUMN NIKOLE HENNESSY KAHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
611 WILSON AVE STE 5, POCATELLO, ID 83201-5046
(208) 915-8448
Mailing address
506 W 37 S, BLACKFOOT, ID 83221-6177
(208) 915-8448
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
ID
Other
Enumeration date
10/14/2025
Last updated
10/14/2025
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