Provider Demographics
NPI:1225827504
Name:UHLENKOTT, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:UHLENKOTT
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 1:1532 W CHILITNA ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1265
Mailing Address - Country:US
Mailing Address - Phone:208-869-9351
Mailing Address - Fax:
Practice Address - Street 1:1532 W CHILITNA ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1265
Practice Address - Country:US
Practice Address - Phone:208-869-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5871557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker