Individual
JACQUELYN DONNA SHOTWELL-VANDERHOOF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1529 S TIMESQUARE LN, STE 200, BOISE, ID 83709-8201
(208) 376-1532
Mailing address
10580 ALPINE ST, NAMPA, ID 83687-5096
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LAMFT-4933
ID
Other
Enumeration date
03/12/2013
Last updated
03/12/2013
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