Healthcare Provider Details

I. General information

NPI: 1386432698
Provider Name (Legal Business Name): ASHLEA WALTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 S ASHLEY ST
ANN ARBOR MI
48104-1351
US

IV. Provider business mailing address

342 S ASHLEY ST
ANN ARBOR MI
48104-1351
US

V. Phone/Fax

Practice location:
  • Phone: 734-726-4196
  • Fax:
Mailing address:
  • Phone: 734-726-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEA WALTON
Title or Position: OWNER
Credential: MSW
Phone: 734-709-6911