Provider Demographics
NPI:1003370958
Name:CROW, JENNY (LMSW, RPT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CROW
Suffix:
Gender:M
Credentials:LMSW, RPT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2995 N COLE RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-576-6464
Mailing Address - Fax:208-392-1378
Practice Address - Street 1:2995 N COLE RD
Practice Address - Street 2:SUITE 270
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-576-6464
Practice Address - Fax:208-392-1378
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW38297104100000X
ID41682104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker