Healthcare Provider Details

I. General information

NPI: 1487005500
Provider Name (Legal Business Name): ASHLEY M ROLLEY LSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 N LIMA RD
POLAND OH
44514-3749
US

IV. Provider business mailing address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

V. Phone/Fax

Practice location:
  • Phone: 330-501-3881
  • Fax:
Mailing address:
  • Phone: 330-787-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1100417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: