Healthcare Provider Details

I. General information

NPI: 1770195372
Provider Name (Legal Business Name): ASHLEY SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 06/30/2026
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17640 NE HALSEY ST
PORTLAND OR
97230-6733
US

IV. Provider business mailing address

3587 HEATHROW WAY
MEDFORD OR
97504-4004
US

V. Phone/Fax

Practice location:
  • Phone: 503-489-5045
  • Fax: 503-489-5638
Mailing address:
  • Phone: 541-858-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPROFESSIONALLICENSE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: