Provider Demographics
NPI:1689936882
Name:SILAKOSKI, JENNA (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:SILAKOSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 N HESS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8716
Mailing Address - Country:US
Mailing Address - Phone:208-772-5204
Mailing Address - Fax:208-772-5275
Practice Address - Street 1:8880 N HESS ST STE 1
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8716
Practice Address - Country:US
Practice Address - Phone:208-772-5204
Practice Address - Fax:208-772-5275
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine