Individual
JADEN CHARLOTTE-MARGARET PROVANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2995 N COLE RD, BOISE, ID 83704-5964
(208) 957-3950
Mailing address
2995 N COLE RD, BOISE, ID 83704-5964
(208) 957-3950
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
45221
ID
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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