Healthcare Provider Details

I. General information

NPI: 1467928655
Provider Name (Legal Business Name): ASHLEY JEAN KOPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 ELM ST STE 207
WASHINGTON MO
63090-2340
US

IV. Provider business mailing address

PO BOX 35
HERMANN MO
65041-0035
US

V. Phone/Fax

Practice location:
  • Phone: 573-680-1390
  • Fax:
Mailing address:
  • Phone: 573-680-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMO2018029242
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: