Healthcare Provider Details

I. General information

NPI: 1003265521
Provider Name (Legal Business Name): JEAN ABRAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 N MAIN ST STE 205
DRIGGS ID
83422-5127
US

IV. Provider business mailing address

565 BOOSHWAY ST
DRIGGS ID
83422-5066
US

V. Phone/Fax

Practice location:
  • Phone: 307-690-0633
  • Fax:
Mailing address:
  • Phone: 307-690-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number37571
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1408
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: