Provider Demographics
NPI:1164543666
Name:KWIATKOWSKI, KATHY LYNN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LYNN
Last Name:KWIATKOWSKI
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 1:455 MOSER CT
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9598
Mailing Address - Country:US
Mailing Address - Phone:208-883-0619
Mailing Address - Fax:208-882-4774
Practice Address - Street 1:814 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3049
Practice Address - Country:US
Practice Address - Phone:208-883-0619
Practice Address - Fax:208-882-4774
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2741101YM0800X
WA5239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health