Healthcare Provider Details

I. General information

NPI: 1285522847
Provider Name (Legal Business Name): ASHLYN COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18698 W PETERSON RD
LIBERTYVILLE IL
60048-1052
US

IV. Provider business mailing address

2930 GLACIER WAY UNIT D
WAUCONDA IL
60084-5056
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-8855
  • Fax:
Mailing address:
  • Phone: 620-920-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: