Provider Demographics
NPI:1629228184
Name:FLOOD, JEANNETTE ELIZABETH (OT,CADC,CCS)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:ELIZABETH
Last Name:FLOOD
Suffix:
Gender:F
Credentials:OT,CADC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W THORNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1665
Mailing Address - Country:US
Mailing Address - Phone:208-344-5611
Mailing Address - Fax:208-333-8831
Practice Address - Street 1:1818 W. STATE ST
Practice Address - Street 2:FIRST STEP FOR WOMEN
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-344-5611
Practice Address - Fax:208-333-8831
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDICADC 8963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty