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Individual

MS. ROWENA KATHRYN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCPC

Contact information

Practice address
531 BRYDEN AVENUE, LEWISTON, ID 83501
(208) 798-1646
(208) 798-5568
Mailing address
531 BRYDEN AVENUE, LEWISTON, ID 83501
(208) 798-1646
(208) 798-5568

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC658
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
806555100
ID
Enumeration date
07/15/2011
Last updated
07/18/2019
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