Individual
DR. GLORIA JENNINGS WATERHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
100 N 1ST AVE, SANDPOINT, ID 83864-1376
(208) 263-2040
Mailing address
100 N 1ST AVE, SANDPOINT, ID 83864-1376
(208) 263-2040
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY202071
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10139177
REGENCE
ID
05
—
806574200
—
ID
01
—
N5327
BLUE CROSS
ID
Enumeration date
10/24/2007
Last updated
11/16/2010
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