Individual
MRS. JENNIFER L ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7623
Mailing address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7623
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
17052
ZZ
1041C0700X
Clinical Social Worker
7177
OK
1041C0700X
Clinical Social Worker
Primary
LCSW-39561
ID
Other
Enumeration date
07/20/2017
Last updated
05/12/2022
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