Individual
JACOB PANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1630 23RD AVE BLDG 2, LEWISTON, ID 83501-6350
(208) 746-7784
(208) 798-8652
Mailing address
PO BOX 812, LEWISTON, ID 83501-0812
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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