Healthcare Provider Details

I. General information

NPI: 1619040458
Provider Name (Legal Business Name): MICHELLE ANNETTE ASHBAUGH ACSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ANNETTE KALP ACSW LSW

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 PELLIS ROAD SUITE 101
GREENSBURG PA
15601
US

IV. Provider business mailing address

438 PELLIS ROAD SUITE 101
GREENSBURG PA
15601
US

V. Phone/Fax

Practice location:
  • Phone: 724-850-7448
  • Fax: 724-850-8143
Mailing address:
  • Phone: 724-850-7448
  • Fax: 724-850-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW-011426-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: