Healthcare Provider Details

I. General information

NPI: 1386143683
Provider Name (Legal Business Name): ASHLEY N WOFFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673MDG 5955 ZEAMER AVE
JBER AK
99506
US

IV. Provider business mailing address

673MDG 5955 ZEAMER AVENUE
JBER AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 618-670-2026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020043
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: