Provider Demographics
NPI:1477936136
Name:LIST, KATHRYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:LIST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-30945
Mailing Address - Street 1:1650 S TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4474
Mailing Address - Country:US
Mailing Address - Phone:208-605-7070
Mailing Address - Fax:
Practice Address - Street 1:9292 W BARNES DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1554
Practice Address - Country:US
Practice Address - Phone:208-795-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW - 30945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLMSW - 30945OtherLMSW LICENCE NUMBER