Jackson, Rowena Kathryn

Jackson, Rowena Kathryn is an individual health care provider with primary practice located at 531 Bryden Avenue , Lewiston ID 83501. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Jackson, Rowena Kathryn can be contacted via phone (208) 798-1646.

Contact Information

Primary practice address
531 Bryden Avenue Lewiston ID 83501
Phone: (208) 798-1646
Fax: (208) 798-5568
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X LPC658 Idaho

Profile Details

NPI number 1306134077
LBN Legal business name Jackson, Rowena Kathryn
Credentials LCPC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2011
Last updated Jul 18th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306134077 NPPES
Idaho MEDICAID 806555100

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