Provider Demographics
NPI:1982846069
Name:EASON-BARNETT, JENNIFER SHAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SHAWN
Last Name:EASON-BARNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 E QUAIL RUN RD
Mailing Address - Street 2:#1
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-5059
Mailing Address - Country:US
Mailing Address - Phone:208-365-5445
Mailing Address - Fax:
Practice Address - Street 1:501 N 16TH ST
Practice Address - Street 2:#110
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2781
Practice Address - Country:US
Practice Address - Phone:208-642-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9927491041C0700X
ID317761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical