Individual
MRS. KAYLENE MARIE WHITTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1975 CURLEW, IDAHO FALLS, ID 83406
(208) 529-4300
(208) 529-1627
Mailing address
2037 LA RAIN CT, IDAHO FALLS, ID 83402-4853
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW-25177
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148963
REGENCE BLUE SHIELD
ID
Enumeration date
09/05/2006
Last updated
07/08/2007
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