Individual
KATHLEEN RENE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SE202993
Contact information
Practice address
1000 N 8TH AVE, POCATELLO, ID 83201-5757
(208) 232-6260
(208) 232-6259
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
(208) 232-2408
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
SE202993
ID
Other
Enumeration date
10/06/2016
Last updated
10/06/2016
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