Individual
MYKELL VALENTINA JEPPESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, CADC
Contact information
Practice address
685 1ST ST, IDAHO FALLS, ID 83401-4003
(208) 932-4493
Mailing address
223 GEORGETOWN DR # SR, REXBURG, ID 83440-5274
(806) 477-9722
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
CADC-5049
ID
2084P0800X
Psychiatry Physician
Primary
LMSW-43873
ID
Other
Enumeration date
11/20/2023
Last updated
12/05/2023
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