Healthcare Provider Details

I. General information

NPI: 1578255733
Provider Name (Legal Business Name): WILLOW ROSE ABRAHAMSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 A. WEST AGENCY ROAD CEDAR HOUSE MENTAL WELLNESS & RECOVERY SERVICES
FORT HALL ID
83203-0040
US

IV. Provider business mailing address

PO BOX 40 85 A WEST AGENCY ROAD
FORT HALL ID
83203-0040
US

V. Phone/Fax

Practice location:
  • Phone: 208-478-4026
  • Fax:
Mailing address:
  • Phone: 208-478-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861419
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: