Healthcare Provider Details

I. General information

NPI: 1487626529
Provider Name (Legal Business Name): JILL EFTA BREITBACH PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W HANLEY AVE STE 101
COEUR D ALENE ID
83815-8994
US

IV. Provider business mailing address

509 W HANLEY AVE STE 101
COEUR D ALENE ID
83815-8994
US

V. Phone/Fax

Practice location:
  • Phone: 208-666-0357
  • Fax: 208-666-0468
Mailing address:
  • Phone: 208-666-0357
  • Fax: 208-666-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number203499
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number203499
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: