Provider Demographics
NPI:1194208306
Name:CONNORS, JAMIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CONNORS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:BUSSIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3525 E LOUISE DR SUITE 500
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-706-7050
Mailing Address - Fax:
Practice Address - Street 1:3525 E LOUISE DR SUITE 500
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3555
Practice Address - Country:US
Practice Address - Phone:208-706-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-37941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical