Individual
KATELEN FORTUNATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6126 W STATE ST STE 310, BOISE, ID 83703-2741
(208) 484-5737
Mailing address
6126 W STATE ST STE 206, BOISE, ID 83703-2741
(208) 917-3114
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
40125
ID
Other
Enumeration date
09/03/2014
Last updated
02/26/2024
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