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NPI Code Detail

MEDICARE: JENNIFER WESEMAN LCPC

MEDICARE:   JENNIFER  WESEMAN  LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLPC-7700ID
2101YM0800XMental Health CounselorLCPC-9127ID

General Provider Information

NPI Number : 1003425547
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WESEMAN LCPC
Provider Business Mailing Address
First Line : 175 E 50TH ST
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-1413
Country : US
Telephone Number : 208-917-1863
Fax Number : 208-906-0815
Provider Business Practice Location Address
First Line : 175 E 50TH ST
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-1413
Country : US
Telephone Number : 208-917-1863
Fax Number : 208-906-0815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2020
Last Update Date : 06/05/2023

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Directions to “ JENNIFER WESEMAN LCPC” Practice Location

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