Provider Demographics
NPI:1336554443
Name:SCHWENNEN, KATELYN MARY (LMSW)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARY
Last Name:SCHWENNEN
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 1:1092 EASTLAND DR N
Mailing Address - Street 2:SUITE C
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8442
Mailing Address - Country:US
Mailing Address - Phone:208-736-0695
Mailing Address - Fax:208-735-2482
Practice Address - Street 1:1092 EASTLAND DR N
Practice Address - Street 2:SUITE C
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8442
Practice Address - Country:US
Practice Address - Phone:208-736-0695
Practice Address - Fax:208-735-2482
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-339251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical