MEDICARE: AMBER ASHFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	12236	TN

General Provider Information

NPI Number	:	1588399372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ASHFORD

Provider Business Mailing Address
First Line	:	9631 S CICERO AVE # 1211
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2528 W 111 ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655
Country	:	US
Telephone Number	:	773-234-4214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	07/18/2022

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Directions to “ AMBER ASHFORD ” Practice Location

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