Provider Demographics
NPI:1891007399
Name:HADLEY, KRISTIN S (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:HADLEY
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 428
Mailing Address - Street 2:
Mailing Address - City:COUNCIL
Mailing Address - State:ID
Mailing Address - Zip Code:83612-0428
Mailing Address - Country:US
Mailing Address - Phone:208-253-6850
Mailing Address - Fax:208-253-6849
Practice Address - Street 1:205 N BERKLEY STEET
Practice Address - Street 2:
Practice Address - City:COUNCIL
Practice Address - State:ID
Practice Address - Zip Code:83612
Practice Address - Country:US
Practice Address - Phone:208-253-6850
Practice Address - Fax:208-253-6849
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-283331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical