Individual
JEREMIAH RANDOLPH JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1087 E PARK BLVD, BOISE, ID 83712
(208) 369-9168
Mailing address
1566 E INDEPENDENCE ST, BOISE, ID 83706-5630
(208) 914-1424
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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