Provider Demographics
NPI:1255192662
Name:WILHITE, KATE RYAN
Entity type:Individual
Prefix:MISS
First Name:KATE
Middle Name:RYAN
Last Name:WILHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 W BEACON LIGHT RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-2419
Mailing Address - Country:US
Mailing Address - Phone:208-577-1094
Mailing Address - Fax:
Practice Address - Street 1:1905 S TOPAZ WAY STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4477
Practice Address - Country:US
Practice Address - Phone:208-518-0870
Practice Address - Fax:800-513-7773
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician