Provider Demographics
NPI:1114446325
Name:STROUT, JENNIFER ROSE (L LMSW-37035)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROSE
Last Name:STROUT
Suffix:
Gender:F
Credentials:L LMSW-37035
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 UNIVERSITY AVE E
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-6155
Mailing Address - Country:US
Mailing Address - Phone:208-934-5880
Mailing Address - Fax:208-934-5876
Practice Address - Street 1:215 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-6155
Practice Address - Country:US
Practice Address - Phone:208-934-5880
Practice Address - Fax:208-934-5876
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker