Provider Demographics
NPI:1124131347
Name:GWIN, MARGARET CATHERINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:CATHERINE
Last Name:GWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 KOOTENAI ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2326
Mailing Address - Country:US
Mailing Address - Phone:208-343-4855
Mailing Address - Fax:208-343-4856
Practice Address - Street 1:2901 KOOTENAI ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2326
Practice Address - Country:US
Practice Address - Phone:208-343-4855
Practice Address - Fax:208-343-4856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202202103TC0700X
OR1193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN6036OtherBLUE CROSS OF IDAHO
ID000010149803OtherBLUE SHIELD OF IDAHO
IDN6036OtherBLUE CROSS OF IDAHO