Individual
JENNIFER PETTY LAYTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
4650 HAWTHORNE RD STE 3B, CHUBBUCK, ID 83202-2376
(208) 244-2765
Mailing address
9508 W CHARLOTTE DR, POCATELLO, ID 83204-7210
(208) 244-2765
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-24471
ID
Other
Enumeration date
07/02/2024
Last updated
07/02/2024
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