Provider Information for 1467824318
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Mrs. RENE L. JOURDAN LCPC
Sex: Female
NPI: 1467824318
Last Updated: 2024-06-26
Certification Date: 2023-01-11
Certification Date: 2023-01-11
Details
| Name | Value | ||||||||||||||
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| NPI | 1467824318 | ||||||||||||||
| Enumeration Date | 2015-10-30 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1033 BALDY MOUNTAIN RD STE 103 SANDPOINT, ID 83864-9203 United States Phone: 208-627-3791 | Fax: | ||||||||||||||
| Primary Practice Address | 1033 BALDY MOUNTAIN ROAD ST 103 SANDPOINT, ID 83864 United States Phone: 208-269-4904 | Fax: | ||||||||||||||
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