Individual
JENNIE ELLEN DENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1740 E 17TH ST, IDAHO FALLS, ID 83404-6375
(208) 524-1278
Mailing address
3625 SYCAMORE CIR, IDAHO FALLS, ID 83402-4708
(208) 221-8599
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW 26010
ID
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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