MEDICARE: ASHLEY JORDAN BULL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		ID

General Provider Information

NPI Number	:	1588591242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY JORDAN BULL

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-0362
Country	:	US
Telephone Number	:	208-949-6888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 N LAKES PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5939
Country	:	US
Telephone Number	:	208-890-7165
Fax Number	:	208-936-4850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “ ASHLEY JORDAN BULL ” Practice Location

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