Individual
MRS. JAQUELYNN ELIZABETH CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2596 N STOKESBERRY PL, MERIDIAN, ID 83646-6114
(208) 918-1636
Mailing address
2596 N STOKESBERRY PL, MERIDIAN, ID 83646-6114
(208) 918-1636
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
8684
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8684
—
ID
Enumeration date
03/24/2022
Last updated
03/24/2022
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