Individual
JACKY ANN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 S MAIN ST, PAYETTE, ID 83661-2853
(208) 405-0020
Mailing address
9 N 3RD ST W, HOMEDALE, ID 83628-3133
(208) 870-2729
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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