Healthcare Provider Details

I. General information

NPI: 1831029792
Provider Name (Legal Business Name): KATIE JOHNSON ASTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 W STATE ST STE 204
BOISE ID
83703-2741
US

IV. Provider business mailing address

4602 W FARM VIEW DR
BOISE ID
83714-9325
US

V. Phone/Fax

Practice location:
  • Phone: 208-479-1116
  • Fax:
Mailing address:
  • Phone: 435-764-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1281117
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: