Healthcare Provider Details

I. General information

NPI: 1366211062
Provider Name (Legal Business Name): ASHLEY HAAG LICENSED SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N VANDEMARK RD
SIDNEY OH
45365-3567
US

IV. Provider business mailing address

3620 HEATHWOOD DR
TIPP CITY OH
45371-8822
US

V. Phone/Fax

Practice location:
  • Phone: 937-622-7393
  • Fax:
Mailing address:
  • Phone: 567-356-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512648
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: