Provider Demographics
NPI:1740765528
Name:RHOADS, KELLY JEAN (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:RHOADS
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 1:2195 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2624
Mailing Address - Country:US
Mailing Address - Phone:208-769-2737
Mailing Address - Fax:
Practice Address - Street 1:2195 IRONWOOD CT
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2624
Practice Address - Country:US
Practice Address - Phone:208-769-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37807104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker