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General NPI Number Information
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NPI Number | 1548047103
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Entity Type | Individual
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Provider Name | JESSICA RENEE ISAAK LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 1276 W RIVER ST STE 100
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City | BOISE
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State | ID
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Zip | 83702-7083
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Country | US
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Telephone | 208-609-1926
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Fax |
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Provider Business Mailing Address
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Address Line | 2008 E MAPLE ST
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City | CALDWELL
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State | ID
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Zip | 83605-5515
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Country | US
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Telephone | 208-609-1926
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW-44126
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License Number State | ID
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