=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396608568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA JELINEK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6807 CODY ST
-----------------------------------------------------
City | BONNERS FERRY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83805-8613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-267-0900
-----------------------------------------------------
Fax | 208-267-6100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6625 JACKSON ST
-----------------------------------------------------
City | BONNERS FERRY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83805-8604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-267-0900
-----------------------------------------------------
Fax | 208-267-6100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------