Individual
KATHLEEN VICTORIA PODUSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
502 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5298
(208) 346-7500
(208) 346-7501
Mailing address
4159 LOWELL BLVD, DENVER, CO 80211-1658
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-8421
ID
101YP2500X
Professional Counselor
0014263
CO
101YP2500X
Professional Counselor
BBH-LCPC-LIC-23176
MT
Other
Enumeration date
08/20/2017
Last updated
12/11/2023
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