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General NPI Number Information
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NPI Number | 1134560113
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Entity Type | Individual
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Provider Name | JENNIFER VANEGAS LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 9850 W ST LUKES DR STE 270
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City | NAMPA
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State | ID
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Zip | 83687-7912
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Country | US
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Telephone | 208-381-5970
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Fax | 208-381-5971
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 39380
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW-44773
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License Number State | ID
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