MEDICARE: DR. JO-ELLEN WATSON PH.D. , LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCSW-40458	ID
2	1041C0700X	Clinical Social Worker	LW00008179	WA
3	1041C0700X	Clinical Social Worker	LCSW-40458	ID

General Provider Information

NPI Number	:	1285425520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JO-ELLEN WATSON PH.D. , LICSW

Provider Business Mailing Address
First Line	:	505 S ASH ST APT 120
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6938
Country	:	US
Telephone Number	:	206-715-2733
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 S ASH ST APT 120
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6938
Country	:	US
Telephone Number	:	206-715-2733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	01/29/2026

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