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General NPI Number Information
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NPI Number | 1578255733
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Entity Type | Individual
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Provider Name | WILLOW ROSE ABRAHAMSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 85 A. WEST AGENCY ROAD CEDAR HOUSE MENTAL WELLNESS & RECOVERY SERVICES
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City | FORT HALL
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State | ID
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Zip | 83203-0040
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Country | US
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Telephone | 208-478-4026
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40 85 A WEST AGENCY ROAD
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City | FORT HALL
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State | ID
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Zip | 83203-0040
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Country | US
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Telephone | 208-478-3967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8861419
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License Number State | ID
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