Individual
JILL REID WEADICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1075 S UTAH AVE STE 354, IDAHO FALLS, ID 83402-3320
(208) 529-5777
(208) 529-5778
Mailing address
6133 S MARBRISA LN, IDAHO FALLS, ID 83406-8243
(208) 569-8288
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-2986
ID
Other
Enumeration date
02/19/2006
Last updated
10/13/2023
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