Individual
MRS. JESSICA LAMAE CUSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1200 W IRONWOOD DR, COEUR D ALENE, ID 83814-2660
(208) 664-9729
Mailing address
1007 N 11TH ST, COEUR D ALENE, ID 83814-4420
(509) 969-9254
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
37733
ID
Other
Enumeration date
05/29/2018
Last updated
05/29/2018
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