Healthcare Provider Details

I. General information

NPI: 1962084517
Provider Name (Legal Business Name): MRS. ASHLEY OTWELL JETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 DOGWOOD DR
MULGA AL
35118-9309
US

IV. Provider business mailing address

307 DOGWOOD DR
MULGA AL
35118-9309
US

V. Phone/Fax

Practice location:
  • Phone: 334-318-7937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6214C
License Number StateAL

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: