Jennifer Miesch, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-202631 Issued in ID

Practice address

231 N 6TH Ave
Pocatello, ID 83201-6211

Phone

(208) 254-1694

Fax

(208) 904-4458

NPI assigned

Sep 26, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 15, 2024 through Nov 15, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jennifer Miesch PHD

  • Clinical Psychologist
  • Pocatello, ID
  • NPI 1164145926
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1558084319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 N 6TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016211",
            "telephone_number": "208-254-1694",
            "fax_number": "208-904-4458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 N 6TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016211",
            "telephone_number": "208-254-1694",
            "fax_number": "208-904-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIESCH",
        "first_name": "JENNIFER",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY-202631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael R Flandro OD PA
• Michael T McHugh D.D.S., PA
• Michael T. Callaghan M.D. & Associates, P.a.
• Amber Mickelsen
• Brandon C Mickelsen, D.O.
• Mariette Milbrandt, CCC-SLP
• Carol Milder, NP
• Miles Counseling LLC
• James Miles, PHARMD
• Jennifer Marie Miles, LCSW

• Psychologist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.