Individual
DR. JENNIFER LESLIE GALLUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
427 N 4TH AVE, POCATELLO, ID 83201-6341
(208) 274-5925
Mailing address
427 N 4TH AVE, POCATELLO, ID 83201-6341
(208) 406-2492
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
Primary
203485
ID
Other
Enumeration date
10/23/2023
Last updated
04/01/2025
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