Individual
MS. JENNIFER VICIEDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LCPC
Contact information
Practice address
2050 FAIRWAY DR, SUITE 111, BOZEMAN, MT 59715-5806
(406) 570-3547
Mailing address
424 N WALLACE AVE, BOZEMAN, MT 59715-3756
(406) 570-3547
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2174 LCPC
MT
101YM0800X
Mental Health Counselor
2174 LCPC
MT
101YP2500X
Professional Counselor
Primary
2174 LCPC
MT
Other
Enumeration date
03/23/2012
Last updated
09/04/2015
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