Provider Demographics
NPI:1932331543
Name:DURTSCHI, JACOB CURT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:CURT
Last Name:DURTSCHI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 1/2 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5422
Mailing Address - Country:US
Mailing Address - Phone:208-890-8391
Mailing Address - Fax:
Practice Address - Street 1:500 W IDAHO ST
Practice Address - Street 2:STE 251
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5754
Practice Address - Country:US
Practice Address - Phone:208-890-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-296071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical