Individual
JENNIFER RAE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
254 E ST STE B, IDAHO FALLS, ID 83402
(208) 529-1854
(208) 523-5974
Mailing address
254 E ST STE B, IDAHO FALLS, ID 83402
(208) 529-1854
(208) 523-5974
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
8921852
—
104100000X
Social Worker
Primary
LSW-42274
ID
Other
Enumeration date
11/15/2022
Last updated
07/16/2026
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