Healthcare Provider Details

I. General information

NPI: 1114359668
Provider Name (Legal Business Name): ASHLEY DAWN REPINSKI MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

IV. Provider business mailing address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

V. Phone/Fax

Practice location:
  • Phone: 312-448-7938
  • Fax:
Mailing address:
  • Phone: 312-448-7938
  • Fax: 312-943-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: