Provider Demographics
NPI:1003425547
Name:WESEMAN, JENNIFER (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WESEMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1413
Mailing Address - Country:US
Mailing Address - Phone:208-917-1863
Mailing Address - Fax:208-906-0815
Practice Address - Street 1:175 E 50TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1413
Practice Address - Country:US
Practice Address - Phone:208-917-1863
Practice Address - Fax:208-906-0815
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7700101YM0800X
IDLCPC-9127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health