Provider Demographics
NPI:1467250282
Name:PRAGGASTIS, JENNA (LPC INTERN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:PRAGGASTIS
Suffix:
Gender:
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8677 N WAYNE DR STE B
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-5190
Mailing Address - Country:US
Mailing Address - Phone:208-762-3475
Mailing Address - Fax:208-625-2086
Practice Address - Street 1:8677 N WAYNE DR STE B
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-5190
Practice Address - Country:US
Practice Address - Phone:208-762-3475
Practice Address - Fax:208-625-2086
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional