Individual
JESSICA NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1329 AMMON PARK DR, AMMON, ID 83406-4591
(208) 534-5554
(208) 534-5580
Mailing address
1329 AMMON PARK DR, AMMON, ID 83406-4591
(208) 534-5554
(208) 534-5580
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-34184
ID
Other
Enumeration date
02/19/2013
Last updated
06/26/2023
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