Healthcare Provider Details

I. General information

NPI: 1124939392
Provider Name (Legal Business Name): ASPEN WOODEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E MAGIC VIEW DR STE 192
MERIDIAN ID
83642-6246
US

IV. Provider business mailing address

5921 N PIERCE PARK LN
BOISE ID
83714-7909
US

V. Phone/Fax

Practice location:
  • Phone: 877-341-2121
  • Fax:
Mailing address:
  • Phone: 208-590-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: