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General NPI Number Information
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NPI Number | 1013161009
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Entity Type | Individual
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Provider Name | JACQUELINE W SABO LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | WILDFLOWER COUNSELING, LLC 104 9TH AVE S STE B2
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City | NAMPA
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State | ID
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Zip | 83651-3809
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Country | US
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Telephone | 208-993-0559
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Fax |
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Provider Business Mailing Address
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Address Line | WILDFLOWER COUNSELING, LLC 1123 12TH AVE RD, #274
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City | NAMPA
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State | ID
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Zip | 83686-5738
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Country | US
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Telephone | 208-315-6640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-4151
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License Number State | ID
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