Provider Demographics
NPI:1083143382
Name:SHELDEN, KIMBERLY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:SHELDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 W PARK PL
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2787
Mailing Address - Country:US
Mailing Address - Phone:208-769-4222
Mailing Address - Fax:208-667-7557
Practice Address - Street 1:2205 IRONWOOD PL STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2487
Practice Address - Country:US
Practice Address - Phone:208-769-4222
Practice Address - Fax:208-667-7557
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36782101YM0800X
IDLCSW-391991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health