Kathleen Rene Smith, SE202993

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

SE202993 Issued in ID

Practice address

1000 N 8TH Ave
Pocatello, ID 83201-5757

Phone

(208) 232-6260

Fax

(208) 232-6259

NPI assigned

Oct 6, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kathleen Rene Schroeder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475712000000",
    "number": "1235689902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE STE 400",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014880",
            "telephone_number": "208-232-7862",
            "fax_number": "208-232-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N 8TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015757",
            "telephone_number": "208-232-6260",
            "fax_number": "208-232-6259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATHLEEN",
        "middle_name": "RENE",
        "credential": "SE202993",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-06",
        "last_updated": "2016-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "SE202993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "SCHROEDER",
            "middle_name": "RENE",
            "credential": "MA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caleb Smith
• Deanna Sue Smith, LCSW
• Edward Gregory Smith, M.S., CCC-A
• Jessie Dean Smith, D.C.
• Joel C Smith, DDS
• Keri J Smith
• Mandy Smith, PTA
• Marielle Smith
• Marilla Michelle Smith
• Maya Smith

• Clinical Psychologist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.