Provider Demographics
NPI:1487389391
Name:KINKLE, MARIANN (MG 61298440)
Entity type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:KINKLE
Suffix:
Gender:F
Credentials:MG 61298440
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 W JOHN LOOP APT 306
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7225
Mailing Address - Country:US
Mailing Address - Phone:208-704-4299
Mailing Address - Fax:
Practice Address - Street 1:721 N PINES RD STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5225
Practice Address - Country:US
Practice Address - Phone:509-892-1100
Practice Address - Fax:509-922-7947
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61298440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist