Healthcare Provider Details

I. General information

NPI: 1730092602
Provider Name (Legal Business Name): WENDY ELAINE EWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY GARNER

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 S 9TH AVE
CALDWELL ID
83605-5075
US

IV. Provider business mailing address

20436 WEYMOUTH PL
CALDWELL ID
83605-1321
US

V. Phone/Fax

Practice location:
  • Phone: 208-454-8555
  • Fax:
Mailing address:
  • Phone: 435-790-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: