Basic Information
| Provider Information | |||||||||
| NPI: | 1629793724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOM | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3027 SATURN AVE | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547030857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152079001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8800 WASHINGTON AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534063705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626333591 | ||||||||
| FaxNumber: | 2626332619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 8113-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.