Healthcare Provider Details

I. General information

NPI: 1912545815
Provider Name (Legal Business Name): ASHLEY STARWOOD LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13242 S ROUTE 59 STE 104
PLAINFIELD IL
60585-5438
US

IV. Provider business mailing address

3833 E MAIN ST STE 1038
SAINT CHARLES IL
60174-2424
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-0380
  • Fax: 630-797-9389
Mailing address:
  • Phone: 630-474-4600
  • Fax: 630-474-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.103927
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.023322
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: