Active NPI
Jessica L Waldron, LCPC
- Professional Counselor
- Idaho Falls, ID
National Provider Identifier
1861588774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LCPC- 3725
- Practice address
- 2420 E 25TH St Ste a
Idaho Falls, ID 83404-7549 - Phone
- (208) 542-1026
- Fax
- (208) 557-7494
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LCPC- 3725 | ID | Primary |
Addresses
Primary practice location
2420 E 25TH St Ste a
Idaho Falls, ID 83404-7549
Mailing address
2420 E 25TH St Ste a
Idaho Falls, ID 83404-7549
Phone (208) 542-1026
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC- 3725 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861588774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2420 E 25TH ST STE A",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047549",
"telephone_number": "208-542-1026",
"fax_number": "208-557-7494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2420 E 25TH ST STE A",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047549",
"telephone_number": "208-542-1026",
"fax_number": "208-557-7494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDRON",
"first_name": "JESSICA",
"middle_name": "L",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LCPC- 3725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.