Individual ProviderJessica NickersonSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1329 Ammon Park Dr, Ammon, ID 83406-4591(208) 534-5554PECOS EnrollmentBased on the most recent information from CMS, provider Jessica Nickerson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1467792036Provider TypeIndividualFull NameNickerson, JessicaCredentialLCSWGenderFemaleSole ProprietorYesEnumeration Date2/19/2013Last Updated6/26/2023Contact InformationPractice LocationPractice Address1329 Ammon Park Dr, Ammon, ID 83406-4591Phone(208) 534-5554Fax(208) 534-5580Mailing LocationMailing Address1329 Ammon Park Dr, Ammon, ID 83406-4591Phone(208) 534-5554Fax(208) 534-5580Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseLCSW-34184Idaho