Basic Information
| Provider Information | |||||||||
| NPI: | 1083143382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHELDEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 W PARK PL | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087694222 | ||||||||
| FaxNumber: | 2086677557 | ||||||||
| Practice Location | |||||||||
| Address1: | 2205 IRONWOOD PL STE B | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087694222 | ||||||||
| FaxNumber: | 2086677557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LMSW-36782 | ID | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCSW-39199 | ID | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.