Provider Demographics
NPI:1356935993
Name:COLTRIN, KRISTEN LEIGH (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH
Last Name:COLTRIN
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 1:6178 N SERENITY LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5071
Mailing Address - Country:US
Mailing Address - Phone:208-941-4498
Mailing Address - Fax:
Practice Address - Street 1:301 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARSING
Practice Address - State:ID
Practice Address - Zip Code:83639
Practice Address - Country:US
Practice Address - Phone:208-941-4498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-40395104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker