Healthcare Provider Details

I. General information

NPI: 1972408037
Provider Name (Legal Business Name): ASHLEIGH KRISTINA LA SALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10547 MONTGOMERY RD # 700
MONTGOMERY OH
45242-4418
US

IV. Provider business mailing address

510 YAK RD APT 862D
FAIRBANKS AK
99709-2485
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 912-515-7241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: