Individual
MR. JASON C SCHICKEDANZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4737 AFTON PL. SANCTUARY NTC, STE #A, CHUBUCK, ID 83202
(208) 417-0623
(208) 417-0641
Mailing address
4737 AFTON PL. SANCTUARY NTC, STE #A, CHUBUCK, ID 83202
(208) 417-0623
(208) 417-0641
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-203074
ID
Other
Enumeration date
08/24/2010
Last updated
02/27/2023
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