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General NPI Number Information
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NPI Number | 1740163609
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Entity Type | Individual
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Provider Name | JESSICA MARTINEZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2005 ARLINGTON AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4808
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Country | US
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Telephone | 208-323-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 1066 N LITTLE CAMAS AVE
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City | STAR
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State | ID
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Zip | 83669-5391
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Country | US
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Telephone | 986-837-2905
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2971065
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2971065
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 2971065
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License Number State | ID
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