Active NPI
Kathy Matlock Tidwell, LCSW
- Clinical Social Worker
- Boise, ID
National Provider Identifier
1083767131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW 858
- Practice address
- 5999 W State St Ste B
Boise, ID 83703-3039 - Phone
- (208) 853-5095
- Fax
- (208) 853-5125
- NPI assigned
- Jan 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW 858 | ID | Primary |
Addresses
Primary practice location
5999 W State St Ste B
Boise, ID 83703-3039
Mailing address
7285 W Franklin Rd
Boise, ID 83709-0926
Phone (208) 853-5095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 858 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568592000000",
"number": "1083767131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7285 W FRANKLIN RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837090926",
"telephone_number": "208-853-5095",
"fax_number": "208-853-5125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5999 W STATE ST STE B",
"city": "BOISE",
"state": "ID",
"postal_code": "837033039",
"telephone_number": "208-853-5095",
"fax_number": "208-853-5125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDWELL",
"first_name": "KATHY",
"middle_name": "MATLOCK",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-20",
"last_updated": "2019-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW 858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
- Jeremiah Lee Tibbitts, DC
- Brook Rose Tiddens, CNM
- Tides Treatment Services
- Tidwell Social Work Services and Consulting, Inc.
- Tidwell Social Work Services and Consulting, Inc. (Tidwell Social Work Services and Consulting)
- Kathleen Tierney, NP
- Quinn Tierney, LCSW
- Shannon Marie Tierney, MD
- Andrew Tietjen, FNP
- Karl Scott Tiffany, LCPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.