Individual
JERRILYNNE WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC-4457
Contact information
Practice address
111 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 552-2109
Mailing address
111 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 552-2109
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC4457
ID
Other
Enumeration date
09/16/2013
Last updated
09/16/2013
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