Healthcare Provider Details

I. General information

NPI: 1871969923
Provider Name (Legal Business Name): ASHLEY SOTELO-ASHBY LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY SOTELO

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 19TH AVE NW
CLINTON IA
52732-2752
US

IV. Provider business mailing address

1320 19TH AVE NW
CLINTON IA
52732-2752
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-5633
  • Fax: 563-243-9567
Mailing address:
  • Phone: 563-243-5633
  • Fax: 563-243-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077218
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: