Healthcare Provider Details

I. General information

NPI: 1265863153
Provider Name (Legal Business Name): ASHLEY LYLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 N UNIVERSITY ST STE 204
PEORIA IL
61614-8302
US

IV. Provider business mailing address

7820 N UNIVERSITY ST STE 204
PEORIA IL
61614-8302
US

V. Phone/Fax

Practice location:
  • Phone: 309-863-2593
  • Fax: 309-966-0861
Mailing address:
  • Phone: 309-863-2593
  • Fax: 309-966-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: