Provider Demographics
NPI:1649014457
Name:MAGANA, JASMINE LIZETH
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LIZETH
Last Name:MAGANA
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 1:11639 W RANA DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6776
Mailing Address - Country:US
Mailing Address - Phone:208-477-8976
Mailing Address - Fax:
Practice Address - Street 1:1224 1ST ST S STE 302
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3963
Practice Address - Country:US
Practice Address - Phone:208-495-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMSW-37198104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker