Provider Demographics
NPI:1477640811
Name:GAGE, KATHERINE A (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:GAGE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SOUTHWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-746-1333
Mailing Address - Fax:208-746-8090
Practice Address - Street 1:222 SOUTHWAY
Practice Address - Street 2:SUITE C
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-746-1333
Practice Address - Fax:208-746-8090
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 7891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010142303OtherBCBS
ID1693028Medicare ID - Type Unspecified