Healthcare Provider Details

I. General information

NPI: 1326519901
Provider Name (Legal Business Name): JEAN P ESPIL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POLK ST STE A
TWIN FALLS ID
83301-3916
US

IV. Provider business mailing address

550 POLK ST STE A
TWIN FALLS ID
83301-3916
US

V. Phone/Fax

Practice location:
  • Phone: 208-737-0572
  • Fax:
Mailing address:
  • Phone: 208-737-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-37138
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: