Doctor Name: | JESSICA MARLEY |
NPI Number: | 1033551080 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | |
Business Practice Address: | 2420 E 25th St Idaho Falls, ID - 834047549 |
Business Phone Number: | 2085421026 |
Business Fax Number: | 2085282945 |
Mailing Address: | 2420 E 25th St, IDAHO FALLS |
State: | ID |
Postal Code: | 834047549 |
Phone Number: | 2085421026 |
Fax Number: | 2085282945 |
NPI Enumeration Date: | 07/18/2013 |
NPI Last Update Date: | 07/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |