Basic Information
| Provider Information | |||||||||
| NPI: | 1356596019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHMAN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | LCPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 HILLWAY DR | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837020929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088614178 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1910 N LAKES PL | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836465939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083422273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2008 | ||||||||
| LastUpdateDate: | 11/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LCPC 4017 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.