Provider Demographics
NPI:1992997837
Name:MICHAUD, KATHLEEN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140544
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-0544
Mailing Address - Country:US
Mailing Address - Phone:208-985-3340
Mailing Address - Fax:208-629-1358
Practice Address - Street 1:5995 W STATE ST STE A
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83703-3085
Practice Address - Country:US
Practice Address - Phone:208-985-3340
Practice Address - Fax:208-629-1358
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical