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General NPI Number Information
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NPI Number | 1487626529
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Entity Type | Individual
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Provider Name | JILL EFTA BREITBACH PSY D
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Gender | Female
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 296 W. SUNSET AVE STE 15
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City | COEUR D'ALENE
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State | ID
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Zip | 83815-8366
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Country | US
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Telephone | 208-666-0357
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Fax | 208-666-0468
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Provider Business Mailing Address
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Address Line | 296 W. SUNSET AVE STE 15
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City | COEUR D'ALENE
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State | ID
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Zip | 83815-8366
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Country | US
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Telephone | 208-666-0357
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Fax | 208-666-0468
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1287
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License Number State | AL
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