Healthcare Provider Details

I. General information

NPI: 1851246466
Provider Name (Legal Business Name): ASHLEY S DOMINICK SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E MONROE AVE
BARRON WI
54812-1479
US

IV. Provider business mailing address

PO BOX 1072
CUMBERLAND WI
54829-1072
US

V. Phone/Fax

Practice location:
  • Phone: 715-537-6332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21089-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: