Provider Demographics
NPI:1346702008
Name:JAMES, KIM HEGG (LMSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:HEGG
Last Name:JAMES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:HEGG-JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:3322 E RED STONE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8582
Mailing Address - Country:US
Mailing Address - Phone:208-863-3601
Mailing Address - Fax:
Practice Address - Street 1:204 10TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3832
Practice Address - Country:US
Practice Address - Phone:208-466-2229
Practice Address - Fax:208-466-2667
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID34033104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker