Provider Demographics
NPI:1679723282
Name:NEIGHBORS, JESSICA SHAKESPEARE (PSYD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SHAKESPEARE
Last Name:NEIGHBORS
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S BRIDGEWAY PL STE 280
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6834
Mailing Address - Country:US
Mailing Address - Phone:208-412-7740
Mailing Address - Fax:208-853-1318
Practice Address - Street 1:1025 S BRIDGEWAY PL STE 280
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6834
Practice Address - Country:US
Practice Address - Phone:208-412-7740
Practice Address - Fax:208-853-1318
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID288251041C0700X
IDPSY203874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical