Individual
SUSAN L KOEPNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2311 PARK AVE, UNIT 3 SUITE 12, BURLEY, ID 83318-2170
(208) 678-3555
(208) 678-3556
Mailing address
323 WAUNA VISTA DR, BURLEY, ID 83318-3447
(208) 731-1711
(208) 678-3556
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-3103
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-3103
STATE OF IDAHO
ID
Enumeration date
11/01/2007
Last updated
11/01/2007
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