Provider Demographics
NPI:1760058846
Name:KINKAID, SAMANTHA (PHDC, MA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KINKAID
Suffix:
Gender:F
Credentials:PHDC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704C 13TH ST E UNIT 352
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2981
Mailing Address - Country:US
Mailing Address - Phone:406-304-5446
Mailing Address - Fax:
Practice Address - Street 1:309 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2319
Practice Address - Country:US
Practice Address - Phone:406-304-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist