Provider Demographics
NPI:1942875950
Name:WIGEN, ASHLYNN KAYE (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:KAYE
Last Name:WIGEN
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9494 N GOVERNMENT WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9848
Mailing Address - Country:US
Mailing Address - Phone:208-391-3673
Mailing Address - Fax:
Practice Address - Street 1:9494 N GOVERNMENT WAY STE 205
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9848
Practice Address - Country:US
Practice Address - Phone:208-391-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-43636104100000X
ID104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker