Amanda Jack

NPI #1386371235 in Meridian, Idaho

Provider Information

NPI Number: 1386371235
Entity Type: Individual
Name: Amanda Jack
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist
Enumeration Date: Aug 2, 2022
Last Updated: Aug 2, 2022

Practice Location

Address: 2463 E GALA ST
City: Meridian
State: Idaho
ZIP Code: 83642-5209
Phone: (208) 955-7333

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X
Student in an Organized Health Care Education/Training Program	390200000X
Psychologist	103T00000X	Primary

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