MEDICARE: JILL STEWART LPC

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
1	101Y00000X	Counselor	LPC-5015	ID

General Provider Information

NPI Number	:	1598100158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL STEWART LPC

Provider Business Mailing Address
First Line	:	1674 W HILL RD
Second Line	:	SUITE 12
City	:	BOISE
State	:	ID
Zip	:	83702-0958
Country	:	US
Telephone Number	:	208-340-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1674 W HILL RD
Second Line	:	SUITE 12
City	:	BOISE
State	:	ID
Zip	:	83702-0958
Country	:	US
Telephone Number	:	208-340-2052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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Directions to “ JILL STEWART LPC” Practice Location

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