Healthcare Provider Details

I. General information

NPI: 1669956348
Provider Name (Legal Business Name): ASHLEY DAWN WEANT LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W CENTRAL ST
BETHALTO IL
62010-1447
US

IV. Provider business mailing address

200 W CENTRAL ST
BETHALTO IL
62010-1447
US

V. Phone/Fax

Practice location:
  • Phone: 618-565-9734
  • Fax:
Mailing address:
  • Phone: 618-565-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: