Individual
JESSICA IVANCIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LCPC
Contact information
Practice address
3320 N MILWAUKEE ST STE 160, BOISE, ID 83704-0726
(208) 817-0965
Mailing address
3320 N MILWAUKEE ST STE 160, BOISE, ID 83704-0726
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC7364
ID
Other
Enumeration date
04/09/2019
Last updated
02/16/2024
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