Provider Demographics
NPI:1285768705
Name:KENDALL, KRISTINE E (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:E
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E HIGHLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1928
Mailing Address - Country:US
Mailing Address - Phone:208-371-1959
Mailing Address - Fax:
Practice Address - Street 1:740 WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6420
Practice Address - Country:US
Practice Address - Phone:208-343-7797
Practice Address - Fax:208-343-0064
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-9021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010015713OtherREGENCE BLUE SHIELD
IDL9123OtherBLUE CROSS OF IDAHO