Individual
JACQUELYNNE ROSE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1812 N LAKEWOOD DR STE 100, COEUR D ALENE, ID 83814-2635
(208) 966-4476
(208) 966-4475
Mailing address
850 W IRONWOOD DR STE 202, COEUR D ALENE, ID 83814-4903
(208) 664-2175
(208) 664-1226
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
121595
TX
Other
Enumeration date
07/15/2022
Last updated
03/06/2025
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