Provider Demographics
NPI:1972287399
Name:KATELYN SCHWENNEN PLLC
Entity Type:Organization
Organization Name:KATELYN SCHWENNEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SCHWENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-802-7780
Mailing Address - Street 1:112 SHOSHONE ST E STE 210
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6185
Mailing Address - Country:US
Mailing Address - Phone:208-802-7780
Mailing Address - Fax:
Practice Address - Street 1:112 SHOSHONE ST E STE 210
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6185
Practice Address - Country:US
Practice Address - Phone:208-802-7780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)