Healthcare Provider Details

I. General information

NPI: 1821692310
Provider Name (Legal Business Name): JENNIFER WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S ORCHARD ST STE 101
BOISE ID
83705-1916
US

IV. Provider business mailing address

11531 W ARLEN ST
BOISE ID
83713-1500
US

V. Phone/Fax

Practice location:
  • Phone: 208-761-3593
  • Fax: 208-712-6778
Mailing address:
  • Phone: 208-949-9241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: