Healthcare Provider Details

I. General information

NPI: 1801899059
Provider Name (Legal Business Name): MICHAEL A ASHLEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON ST
SWAYZEE IN
46986-9578
US

IV. Provider business mailing address

501 S WASHINGTON ST
SWAYZEE IN
46986-9578
US

V. Phone/Fax

Practice location:
  • Phone: 765-661-1995
  • Fax: 888-419-8515
Mailing address:
  • Phone: 765-661-1995
  • Fax: 888-419-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20090231A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: