Provider Demographics
NPI:1548617756
Name:KERNER, MELODY (LMSW)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:KERNER
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:PO BOX 5935
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-5935
Mailing Address - Country:US
Mailing Address - Phone:208-539-2791
Mailing Address - Fax:208-736-2135
Practice Address - Street 1:803 HARRISON ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3925
Practice Address - Country:US
Practice Address - Phone:208-732-1633
Practice Address - Fax:208-736-2135
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-265321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical