Healthcare Provider Details

I. General information

NPI: 1578243069
Provider Name (Legal Business Name): ASHLI WAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 KAY DR
WEST PLAINS MO
65775-1725
US

IV. Provider business mailing address

1934 KAY DR
WEST PLAINS MO
65775-1725
US

V. Phone/Fax

Practice location:
  • Phone: 417-274-2203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025026986
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: