Individual
MARY AMANDA JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
3990 E 20 N, RIGBY, ID 83442-5818
(208) 390-7373
Mailing address
3990 E 20 N, RIGBY, ID 83442-5818
(208) 390-7373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11526
ID
Other
Enumeration date
11/18/2019
Last updated
11/18/2019
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