Provider Demographics
NPI:1902509383
Name:RIGENHAGEN, AMY FAYE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:FAYE
Last Name:RIGENHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S GOSHEN AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5320
Mailing Address - Country:US
Mailing Address - Phone:208-871-3810
Mailing Address - Fax:
Practice Address - Street 1:2250 S GOSHEN AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5320
Practice Address - Country:US
Practice Address - Phone:208-871-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health