| Katherine Wacholz Agency | |
|
5723 E Dodd Rd Hayden Lake ID 83835-9376 | |
| (208) 699-1704 | |
| Not Available |
| Full Name | Katherine Wacholz Agency |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5723 E Dodd Rd, Hayden Lake, Idaho |
| Authorized Official Name and Position | Katherine Wacholz Wacholz (INDEPENDENT PROVIDER PROFESSIONAL) |
| Authorized Official Contact | 2086991704 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Katherine Wacholz Agency 5723 E Dodd Rd Hayden Lake ID 83835-9376 Ph: (208) 699-1704 | Katherine Wacholz Agency 5723 E Dodd Rd Hayden Lake ID 83835-9376 Ph: (208) 699-1704 |
| NPI Number | 1912542648 |
|---|---|
| Provider Enumeration Date | 11/18/2019 |
| Last Update Date | 11/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912542648 | NPI | - | NPPES |
| 84-2522234 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
K2 Fmily Partnership Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5723 E Dodd Rd, Hayden Lake, ID 83835 Phone: 208-699-1704 | |
Treasure Valley Neurotherapy Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1677 E Miles Ave Ste 100, Hayden Lake, ID 83835 Phone: 208-631-1089 | |
Integrated Interventions Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2482 E. Glacier Rd., Hayden Lake, ID 83835 Phone: 208-651-0095 |