Healthcare Provider Details

I. General information

NPI: 1407369093
Provider Name (Legal Business Name): ASHLEY BAXTER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 DEMOCRAT DR
FRANKFORT KY
40601-9214
US

IV. Provider business mailing address

3300 MONTAVESTA RD APT 4107
LEXINGTON KY
40502-3667
US

V. Phone/Fax

Practice location:
  • Phone: 866-755-4258
  • Fax:
Mailing address:
  • Phone: 859-516-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number252911
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: