Provider Demographics
NPI:1184402943
Name:ZACCONE, JENNIFER RYAN (MD,LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RYAN
Last Name:ZACCONE
Suffix:
Gender:F
Credentials:MD,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6839
Mailing Address - Country:US
Mailing Address - Phone:208-404-9409
Mailing Address - Fax:
Practice Address - Street 1:634 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6839
Practice Address - Country:US
Practice Address - Phone:208-404-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health