Provider Demographics
NPI:1881300226
Name:OWENS, ASHTON (MA, IP)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:MA, IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4692 N LANCER AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0520
Mailing Address - Country:US
Mailing Address - Phone:509-589-0266
Mailing Address - Fax:
Practice Address - Street 1:4692 N LANCER AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0520
Practice Address - Country:US
Practice Address - Phone:509-589-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty