Provider Demographics
NPI:1750741781
Name:WHICKER, JELYN (LMSW)
Entity type:Individual
Prefix:
First Name:JELYN
Middle Name:
Last Name:WHICKER
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 1:1301 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6273
Mailing Address - Country:US
Mailing Address - Phone:801-915-9055
Mailing Address - Fax:
Practice Address - Street 1:5783 WASATCH DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-9815
Practice Address - Country:US
Practice Address - Phone:801-915-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst