Healthcare Provider Details

I. General information

NPI: 1033761234
Provider Name (Legal Business Name): ASHLEY MONITA LIPPENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY SMITH LCSW

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 S DEER RD
MACOMB IL
61455-2602
US

IV. Provider business mailing address

927 BROADWAY ST
QUINCY IL
62301-2719
US

V. Phone/Fax

Practice location:
  • Phone: 309-575-3960
  • Fax: 309-575-3988
Mailing address:
  • Phone: 217-224-4453
  • Fax: 217-224-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149020767
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: