=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154035764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY WRIGHT LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2023
-----------------------------------------------------
Last Update Date | 01/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S 3RD W
-----------------------------------------------------
City | SODA SPRINGS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83276-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-547-2766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S 3RD W
-----------------------------------------------------
City | SODA SPRINGS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83276-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-547-2766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LMSW-43013
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------