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Individual

MR. JONATHON JAMES PINGREE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
10740 W FAIRVIEW AVE, SUITE 100, BOISE, ID 83713-7926
(208) 376-0191
(208) 658-6299
Mailing address
2080 W DIVIDE CREEK ST, MERIDIAN, ID 83642-3426
(208) 376-0191
(208) 658-6299

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-25979
ID

Other

Enumeration date
04/13/2007
Last updated
07/08/2007
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