Healthcare Provider Details

I. General information

NPI: 1548682081
Provider Name (Legal Business Name): COURTNEY BREANN JEPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 04/25/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 N WAYNE DRIVE
HAYDEN ID
83835
US

IV. Provider business mailing address

6925 N DEGAS DR
COEUR D ALENE ID
83815-8421
US

V. Phone/Fax

Practice location:
  • Phone: 208-691-5063
  • Fax:
Mailing address:
  • Phone: 208-691-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW79750
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW42899
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: