Healthcare Provider Details

I. General information

NPI: 1124861992
Provider Name (Legal Business Name): ASHLEY BAYLOR LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 N ALPINE RD STE 403
ROCKFORD IL
61107-1440
US

IV. Provider business mailing address

1639 N ALPINE RD STE 403
ROCKFORD IL
61107-1440
US

V. Phone/Fax

Practice location:
  • Phone: 608-492-1992
  • Fax: 815-229-7108
Mailing address:
  • Phone: 608-492-1992
  • Fax: 815-229-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: