Organization
KATHERINE WACHOLZ AGENCY
Active
Other names
Katherine Wacholz Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHERINE WACHOLZ WACHOLZ M.ED BIP (INDEPENDENT PROVIDER PROFESSIONAL)
(208) 699-1704
Entity
Organization
Contact information
Practice address
5723 E DODD RD, HAYDEN LAKE, ID 83835-9376
(208) 699-1704
Mailing address
5723 E DODD RD, HAYDEN LAKE, ID 83835-9376
(208) 699-1704
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84-2522234
—
ID
Enumeration date
11/18/2019
Last updated
11/18/2019
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