Provider Information for 1356596019
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JENNIFER FISHMAN LCPC, NCC
Sex: Female
NPI: 1356596019
Last Updated: 2008-11-22
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1356596019 | ||||||||
| Enumeration Date | 2008-11-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2201 HILLWAY DR BOISE, ID 83702-0929 United States Phone: 208-861-4178 | Fax: | ||||||||
| Primary Practice Address | 1910 N LAKES PL MERIDIAN, ID 83646-5939 United States Phone: 208-342-2273 | Fax: | ||||||||
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