Provider Demographics
NPI:1245986264
Name:RACER, JEANNE B (LCSW)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:B
Last Name:RACER
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 1:594 LOST MILE RD
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-4904
Mailing Address - Country:US
Mailing Address - Phone:208-217-2162
Mailing Address - Fax:
Practice Address - Street 1:147 EMERSON LN
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-6153
Practice Address - Country:US
Practice Address - Phone:208-267-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-417391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical