Healthcare Provider Details

I. General information

NPI: 1235786914
Provider Name (Legal Business Name): ASHLEY LYNN MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W SPRINGFIELD AVE
CHAMPAIGN IL
61820-4716
US

IV. Provider business mailing address

2302 MORELAND BLVD
CHAMPAIGN IL
61822-1398
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-8464
  • Fax:
Mailing address:
  • Phone: 217-355-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: