Healthcare Provider Details

I. General information

NPI: 1285003699
Provider Name (Legal Business Name): ASHLEY MARIE SHONIBARE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY MARIE GONSLER LCSW

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE STE 113
CHICAGO IL
60625-3547
US

IV. Provider business mailing address

585 JEWETT RD
MASON MI
48854-8729
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-5300
  • Fax: 773-293-5346
Mailing address:
  • Phone: 517-676-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801097317
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149019637
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: