Provider Demographics
NPI:1104614080
Name:CONKLIN, KATY LYNN
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:LYNN
Last Name:CONKLIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16761 N JADE COVER LN APT 3
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-4222
Mailing Address - Country:US
Mailing Address - Phone:775-901-1031
Mailing Address - Fax:
Practice Address - Street 1:1883 N WILDWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5146
Practice Address - Country:US
Practice Address - Phone:208-754-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health