Healthcare Provider Details

I. General information

NPI: 1003261454
Provider Name (Legal Business Name): JACQUELINE S ASHLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 INDIANA AVE
RIVERSIDE CA
92504-4544
US

IV. Provider business mailing address

PO BOX 55623
RIVERSIDE CA
92517-0623
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6000
  • Fax:
Mailing address:
  • Phone: 323-212-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW70676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: