Individual
JENNIFER WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COUNSELOR INTERN
Contact information
Practice address
317 W 6TH ST STE 208, MOSCOW, ID 83843-2387
(208) 882-3504
Mailing address
421 E 6TH ST APT 3, MOSCOW, ID 83843-2954
(713) 419-5888
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/20/2022
Last updated
12/20/2022
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