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General NPI Number Information
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NPI Number | 1083976146
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Entity Type | Individual
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Provider Name | JENNIFER KEANE LPC
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Gender | Female
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 1717 LINCOLN WAY SUITE 101
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2556
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Country | US
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Telephone | 208-699-5536
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Fax |
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Provider Business Mailing Address
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Address Line | 4938 N SHAW LOOP RD
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City | COEUR D ALENE
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State | ID
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Zip | 83815-7005
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Country | US
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Telephone | 208-699-5536
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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 | LPC-3044
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License Number State | ID
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