Provider Demographics
NPI:1902349814
Name:SEARLE, JENNIFER LYNN (LMSW, QSUDP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:SEARLE
Suffix:
Gender:F
Credentials:LMSW, QSUDP
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:SEARLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, QSUDP
Mailing Address - Street 1:284 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4542
Mailing Address - Country:US
Mailing Address - Phone:208-733-7186
Mailing Address - Fax:208-733-7178
Practice Address - Street 1:284 MARTIN ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4542
Practice Address - Country:US
Practice Address - Phone:208-733-7186
Practice Address - Fax:208-733-7178
Is Sole Proprietor?:No
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36154104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker