Provider Demographics
NPI:1033209796
Name:HAZEN, JENNIE PATRICIA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:PATRICIA
Last Name:HAZEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1549
Mailing Address - Country:US
Mailing Address - Phone:208-515-7661
Mailing Address - Fax:208-908-6164
Practice Address - Street 1:3006 E GOLDSTONE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1549
Practice Address - Country:US
Practice Address - Phone:208-515-7661
Practice Address - Fax:208-908-6164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5665101YP2500X
IDLPC-3644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional