Provider Demographics
NPI:1467042333
Name:WOODS, KENNEDY DANIELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:DANIELLE
Last Name:WOODS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 N COLE RD STE 270
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5991
Mailing Address - Country:US
Mailing Address - Phone:208-576-6464
Mailing Address - Fax:
Practice Address - Street 1:2995 N COLE RD STE 270
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5991
Practice Address - Country:US
Practice Address - Phone:208-576-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW39328104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker