Provider Demographics
NPI:1285200543
Name:WESTOVER, JESSICA KELLEY
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KELLEY
Last Name:WESTOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-0007
Mailing Address - Country:US
Mailing Address - Phone:208-604-2389
Mailing Address - Fax:
Practice Address - Street 1:532 E 1500 N
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-5032
Practice Address - Country:US
Practice Address - Phone:208-604-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician