Provider Demographics
NPI:1053628339
Name:KAES, PAT M
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:M
Last Name:KAES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SHOUP AVE W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5022
Mailing Address - Country:US
Mailing Address - Phone:208-734-6760
Mailing Address - Fax:208-734-6764
Practice Address - Street 1:228 SHOUP AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5022
Practice Address - Country:US
Practice Address - Phone:208-734-6760
Practice Address - Fax:208-734-6764
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3321101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor