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Individual

JENNIFER RAE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LSW

Contact information

Practice address
1810 W BROADWAY ST, IDAHO FALLS, ID 83402-5072
(208) 552-7011
Mailing address
495 W 100 N, BLACKFOOT, ID 83221-5517
(208) 852-6688

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-42274
ID

Other

Enumeration date
11/15/2022
Last updated
11/15/2022
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