Individual
JESSE TANGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
223 16TH AVE N, NAMPA, ID 83687-4058
(208) 466-7869
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 467-4431
(208) 466-5359
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LCSW-38337
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-38337
ID
Other
Enumeration date
10/28/2016
Last updated
02/14/2019
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