Provider Demographics
NPI:1528534377
Name:O'DONNELL, KRISTIN ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:MOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 2ND AVE N
Mailing Address - Street 2:STE 102
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6163
Mailing Address - Country:US
Mailing Address - Phone:208-733-3308
Mailing Address - Fax:208-733-3315
Practice Address - Street 1:155 2ND AVE N
Practice Address - Street 2:STE 102
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6163
Practice Address - Country:US
Practice Address - Phone:208-733-3308
Practice Address - Fax:208-733-3315
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37850104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker