Individual
JESSICA MICHELLE WILSON-LUCERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S, NCSP
Contact information
Practice address
395 1/2 WILLARD AVE, POCATELLO, ID 83201-4524
(208) 240-4063
Mailing address
395 1/2 WILLARD AVE, POCATELLO, ID 83201-4524
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
ID
Other
Enumeration date
09/03/2020
Last updated
09/03/2020
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