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General NPI Number Information
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NPI Number | 1750969721
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Entity Type | Individual
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Provider Name | JENNIFER JIMENEZ
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 250 S MAIN ST
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City | PAYETTE
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State | ID
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Zip | 83661-2853
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Country | US
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Telephone | 208-405-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 818 SW 3RD AVE # 221-4349
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City | PORTLAND
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State | OR
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Zip | 97204-2405
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Country | US
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Telephone | 360-780-3921
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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