Kracke, Kevin Richard

Kracke, Kevin Richard is an individual health care provider with primary practice located at 422 17Th St , Lewiston ID 83501-2526. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Kracke, Kevin Richard can be contacted via phone (208) 743-4680.

Contact Information

Primary practice address
422 17Th St Lewiston ID 83501-2526
Phone: (208) 743-4680
Fax: (208) 743-1756
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X PSY189 Idaho

Profile Details

NPI number 1164416749
LBN Legal business name Kracke, Kevin Richard
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 9th, 2005
Last updated Mar 15th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164416749 NPPES
Idaho Other N4478 BLUE CROSS OF IDAHO
Idaho Other 000010015963 BLUE CROSS OF IDAHO
Idaho MEDICAID 806177700 BLUE CROSS OF IDAHO

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