Active NPI
Jessica Ivancic, MS, LCPC
- Professional Counselor
- Boise, ID
National Provider Identifier
1922561612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LCPC7364
- Practice address
- 3320 N Milwaukee St Ste 160
Boise, ID 83704-0726 - Phone
- (208) 817-0965
- NPI assigned
- Apr 9, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | LCPC7364 | ID | Primary |
Addresses
Primary practice location
3320 N Milwaukee St Ste 160
Boise, ID 83704-0726
Mailing address
3320 N Milwaukee St Ste 160
Boise, ID 83704-0726
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC7364 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708041600000",
"number": "1922561612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3320 N MILWAUKEE ST STE 160",
"city": "BOISE",
"state": "ID",
"postal_code": "837040726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3320 N MILWAUKEE ST STE 160",
"city": "BOISE",
"state": "ID",
"postal_code": "837040726",
"telephone_number": "208-817-0965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVANCIC",
"first_name": "JESSICA",
"credential": "MS, LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-09",
"last_updated": "2024-02-16",
"certification_date": "2024-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LCPC7364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.