Individual
JASON SOUTHWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-2121
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(082) 367-2121
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY - 202728
ID
103TC0700X
Clinical Psychologist
PSY - 202728
ID
Other
Enumeration date
10/17/2012
Last updated
05/18/2024
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