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General NPI Number Information
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NPI Number | 1245967512
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Entity Type | Individual
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Provider Name | JESSICA RAEANNE CHAPMAN
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 30410 HIGHWAY 200 STE 200B-3
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City | PONDERAY
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State | ID
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Zip | 83852-9601
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Country | US
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Telephone | 208-627-7819
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Fax |
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Provider Business Mailing Address
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Address Line | 217 CEDAR ST # 302
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City | SANDPOINT
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State | ID
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Zip | 83864-1410
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Country | US
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Telephone | 208-627-7819
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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 | 42252
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-8911015
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License Number State | ID
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