Healthcare Provider Details

I. General information

NPI: 1922395870
Provider Name (Legal Business Name): ASHLEY DONALDSON WYSOCKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY DONALDSON WITHROW LCSW

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MORGAN ST SUITE 8
PARAGOULD AR
72450-3949
US

IV. Provider business mailing address

1815 PLEASANT GROVE RD
JONESBORO AR
72401-7870
US

V. Phone/Fax

Practice location:
  • Phone: 870-335-9483
  • Fax: 870-335-9487
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6439-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: