Healthcare Provider Details

I. General information

NPI: 1508415316
Provider Name (Legal Business Name): ASHLEY JANE LOCKERT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 COLONEL GLENN RD
LITTLE ROCK AR
72210-5323
US

IV. Provider business mailing address

1900 HALLENBECK LN
LITTLE ROCK AR
72210-5249
US

V. Phone/Fax

Practice location:
  • Phone: 501-821-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9609-M
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: