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General NPI Number Information
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NPI Number | 1134896418
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Entity Type | Individual
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Provider Name | JENNIFER L MINNIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 150 2ND ST
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City | MELBA
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State | ID
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Zip | 83641-5199
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Country | US
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Telephone | 208-459-1011
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Fax | 208-466-5359
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | NAMPA
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State | ID
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Zip | 83653-0009
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Country | US
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Telephone | 208-467-4431
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Fax | 208-466-5359
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-37562
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License Number State | ID
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