Individual
MRS. KATHLEEN S TOMAZIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
90 W JUDICIAL ST, BLACKFOOT, ID 83221-2715
(208) 782-2060
(208) 782-0209
Mailing address
90 W JUDICIAL ST, BLACKFOOT, ID 83221-2715
(208) 782-2060
(208) 782-0209
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LCPC 332
ID
104100000X
Social Worker
Primary
LSW 1810
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8059327
—
ID
05
—
80662262
—
ID
Enumeration date
04/19/2007
Last updated
09/11/2025
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