Provider Demographics
NPI:1740903913
Name:JAEGERMAN, ALYDA ROSE (LMSW)
Entity type:Individual
Prefix:
First Name:ALYDA
Middle Name:ROSE
Last Name:JAEGERMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3131
Mailing Address - Country:US
Mailing Address - Phone:208-310-3606
Mailing Address - Fax:
Practice Address - Street 1:127 S WASHINGTON ST STE 5
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2866
Practice Address - Country:US
Practice Address - Phone:208-310-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-42713104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker