Jerry D. Lilly ED.S
Full Name
Jerry Duane Lilly ED.S
NPI Number
1124390786
NPI Type
Individual Provider
Gender
Male
Enumeration Date
01/29/2012
Specialties
(Taxonomies)Licenses
State
Idaho
License Number
LCPC-6990
Contact
Information
Purpose
Mailing
Location
Address
12073 N HUMPHREYS WAY
172 S ACADEMY AVE STE 160
City
Boise
Eagle
State
ID
ID
Postal Code
83714-9343
83616-6564
Country
US
US
Telephone Number
(208) 315-4855
(208) 315-4855
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 12/06/2023