Healthcare Provider Details

I. General information

NPI: 1487558557
Provider Name (Legal Business Name): CRYSTAL ANN WESTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W USTICK RD STE AND110
MERIDIAN ID
83646-7733
US

IV. Provider business mailing address

228 S FERNAN LAKE WAY
STAR ID
83669-5770
US

V. Phone/Fax

Practice location:
  • Phone: 208-576-6464
  • Fax: 208-396-1378
Mailing address:
  • Phone: 208-571-1917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8921440
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: