Provider Demographics
NPI:1184415572
Name:RAMIREZ, JYSIKA LYNN IRENE
Entity type:Individual
Prefix:
First Name:JYSIKA
Middle Name:LYNN IRENE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-2039
Mailing Address - Country:US
Mailing Address - Phone:208-293-4099
Mailing Address - Fax:
Practice Address - Street 1:545 LAKE ST
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-2039
Practice Address - Country:US
Practice Address - Phone:208-293-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13060101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)