Healthcare Provider Details

I. General information

NPI: 1174042857
Provider Name (Legal Business Name): ASHLEY MARIE KOBYLASZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ASHLEY MARIE JOHNSON

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22209 STEPPE LN
BROWNSTOWN MI
48193-8810
US

IV. Provider business mailing address

22209 STEPPE LN
BROWNSTOWN MI
48193-8810
US

V. Phone/Fax

Practice location:
  • Phone: 734-365-9562
  • Fax:
Mailing address:
  • Phone: 734-365-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: