Provider Demographics
NPI:1760082317
Name:CHASE, KAREN L (MS/BIP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:CHASE
Suffix:
Gender:F
Credentials:MS/BIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 S WIDGEON ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6212
Mailing Address - Country:US
Mailing Address - Phone:208-244-8389
Mailing Address - Fax:
Practice Address - Street 1:673 S WIDGEON ST
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6212
Practice Address - Country:US
Practice Address - Phone:208-244-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician