Individual
YVETTE LISA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
223 N 6TH ST STE 230, BOISE, ID 83702-5954
(208) 991-4696
Mailing address
11421 W KINGS CANYON CT, BOISE, ID 83709-7940
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-33944
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-37582
ID
Other
Enumeration date
12/03/2017
Last updated
07/19/2019
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