Basic Information
| Provider Information | |||||||||
| NPI: | 1053911974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GOLD | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 SHAWNEE RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458053583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199992010 | ||||||||
| FaxNumber: | 4199996284 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | WAPAKONETA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458959347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197383711 | ||||||||
| FaxNumber: | 4197383701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2020 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1100724 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.