Provider Demographics
NPI:1164867107
Name:SAMSEL, KATHLEEN M (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:SAMSEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:STOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6051 N GALEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8989
Mailing Address - Country:US
Mailing Address - Phone:509-599-4720
Mailing Address - Fax:
Practice Address - Street 1:2101 N LAKEWOOD DR
Practice Address - Street 2:STE 226
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2473
Practice Address - Country:US
Practice Address - Phone:208-457-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW 32505104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker