Provider Demographics
NPI:1801969548
Name:GEDEIK, JACQUELINE (LCPC)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:GEDEIK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 E HAYDEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8560
Mailing Address - Country:US
Mailing Address - Phone:208-714-4256
Mailing Address - Fax:
Practice Address - Street 1:1110 E POLSTON AVE
Practice Address - Street 2:SUITE 4 JOURNEY TO WELLNESS COUNSELING
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6409
Practice Address - Country:US
Practice Address - Phone:208-699-6756
Practice Address - Fax:208-457-1202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health