Provider Demographics
NPI:1316124878
Name:SCHRAMM, JOAN KATHLEEN (LCP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:KATHLEEN
Last Name:SCHRAMM
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 COLLISTER DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3719
Mailing Address - Country:US
Mailing Address - Phone:208-343-0539
Mailing Address - Fax:
Practice Address - Street 1:3098 N FIVE MILE RD STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5215
Practice Address - Country:US
Practice Address - Phone:208-376-4999
Practice Address - Fax:208-323-9349
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCP 671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDX6931OtherBLUE CROSS
ID0000159385OtherBLUE SHIELD