Individual
NICOLE DIANA MADILL-KLUPENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC 6404
Contact information
Practice address
687 CAMP NINE RD, BONNERS FERRY, ID 83805-5074
(541) 314-5734
Mailing address
687 CAMP NINE RD, BONNERS FERRY, ID 83805-5074
(541) 314-5734
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-6404
ID
101YP2500X
Professional Counselor
LPC5539
ID
Other
Enumeration date
09/12/2016
Last updated
06/23/2022
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