Individual
JULIETTE JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2031 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-2525
(208) 365-2234
Mailing address
2031 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-2525
(208) 365-2234
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LMSW-38770
ID
104100000X
Social Worker
Primary
LMSW-38770
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMSW-38770
LICENSE TO PRACTICE
ID
Enumeration date
06/25/2020
Last updated
06/25/2020
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