Provider Demographics
NPI:1497788780
Name:JAHNKE, KRISTEN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:JAHNKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 N COLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7365
Mailing Address - Country:US
Mailing Address - Phone:208-323-2273
Mailing Address - Fax:208-323-1234
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-3069
Practice Address - Fax:208-367-3002
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW269781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1697025Medicare ID - Type UnspecifiedLCSW