Healthcare Provider Details

I. General information

NPI: 1285036038
Provider Name (Legal Business Name): JACLYN HAMMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 W EMERALD ST
BOISE ID
83704-8657
US

IV. Provider business mailing address

7025 W EMERALD ST
BOISE ID
83704-8657
US

V. Phone/Fax

Practice location:
  • Phone: 208-947-0863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-38808
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: