Provider Demographics
NPI:1821811472
Name:ENGGAS, JADYN RENE (LMSW)
Entity type:Individual
Prefix:
First Name:JADYN
Middle Name:RENE
Last Name:ENGGAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 N 17TH ST APT C2
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-6606
Mailing Address - Country:US
Mailing Address - Phone:928-379-0584
Mailing Address - Fax:
Practice Address - Street 1:500 N GOVERNMENT WAY STE 300
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2976
Practice Address - Country:US
Practice Address - Phone:928-379-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7161476101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor