Provider Demographics
NPI:1750600862
Name:ANDERST KEUHEY, JODI ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANN
Last Name:ANDERST KEUHEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:ANN
Other - Last Name:ANDERST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2068 S. EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6707
Mailing Address - Country:US
Mailing Address - Phone:208-340-1688
Mailing Address - Fax:208-887-3660
Practice Address - Street 1:2068 S. EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6707
Practice Address - Country:US
Practice Address - Phone:208-340-1688
Practice Address - Fax:208-887-3660
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ID327491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health