Healthcare Provider Details

I. General information

NPI: 1649138017
Provider Name (Legal Business Name): ASHLEY NICOLE MOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 ASH AVE
HAMMOND IN
46327-1436
US

IV. Provider business mailing address

4318 ASH AVE
HAMMOND IN
46327-1436
US

V. Phone/Fax

Practice location:
  • Phone: 708-262-2943
  • Fax:
Mailing address:
  • Phone: 708-262-2943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: