Individual
DR. ELLEN LOUISE JAEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD LP
Contact information
Practice address
1115 IRONWOOD DRIVE, COEUR D ALENE, ID 83814-4936
(208) 765-0955
(208) 765-6972
Mailing address
1115 IRONWOOD DRIVE, COEUR D ALENE, ID 83814-4936
(208) 765-0955
(208) 765-6972
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY202116
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010145796
BLUE CROSS BLUE SHIELD
—
01
—
N5822
BLUE CROSS OF IDAHO
ID
Enumeration date
10/03/2006
Last updated
07/09/2007
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