Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Susan Kelli Shake

Individual provider Counselor · NPI 1114801974

Susan Kelli Shake is a Counselor in Boise, Idaho. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
4

Practice location Address checks out

1655 W Fairview Ave Ste 209
Boise, ID 83702-5190
Phone: (208) 352-0343
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X
Counselor Taxonomy 101Y00000X
Mental Health Counselor Taxonomy 101YM0800X
Professional Counselor Taxonomy 101YP2500X

Record details

NPI number1114801974
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 4, 2025
Last updated in NPPESAugust 4, 2025
Certification dateAugust 4, 2025
Mailing address1655 W Fairview Ave Ste 209, Boise, ID 83702-5190

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