Healthcare Provider Details

I. General information

NPI: 1366206013
Provider Name (Legal Business Name): ASHLEY M HOMSTAD LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 S MECHANIC ST
DECORAH IA
52101-2149
US

IV. Provider business mailing address

1009 S MECHANIC ST
DECORAH IA
52101-2149
US

V. Phone/Fax

Practice location:
  • Phone: 209-247-8530
  • Fax:
Mailing address:
  • Phone: 563-419-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123488
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: