Individual
KENDRA JEAN NIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1901 N LAKES PL STE 150, MERIDIAN, ID 83646-5939
(208) 890-7165
Mailing address
14331 CREGO ST, CALDWELL, ID 83607-4815
(208) 757-0067
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-8629
ID
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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