Individual
JESSICA PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2609 S 10TH AVE STE 102, CALDWELL, ID 83605-6885
(208) 454-2766
Mailing address
702 SUNSET DR, ONTARIO, OR 97914-3121
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/28/2016
Last updated
12/27/2017
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