Provider Demographics
NPI:1114196623
Name:KOESTER, JOANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:KOESTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 409
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-0409
Mailing Address - Country:US
Mailing Address - Phone:208-403-7488
Mailing Address - Fax:208-529-1960
Practice Address - Street 1:2498 N. STOKESBERRY PL.
Practice Address - Street 2:SUITE 180
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-403-7488
Practice Address - Fax:208-529-1960
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806472900Medicaid