Healthcare Provider Details

I. General information

NPI: 1063825826
Provider Name (Legal Business Name): ASHLEY HAMMARGREN FREEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 16TH AVE N
NAMPA ID
83687-4058
US

IV. Provider business mailing address

211 16TH AVE N PO BOX 9
NAMPA ID
83687-4058
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-7869
  • Fax: 208-466-5359
Mailing address:
  • Phone: 208-467-7654
  • Fax: 208-318-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-37068
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: