Healthcare Provider Details

I. General information

NPI: 1235980970
Provider Name (Legal Business Name): ASHLEY LYNN SCHANMIER JOLLY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 PROSPECT AVE STE 210
BELOIT WI
53511-6336
US

IV. Provider business mailing address

300 MILL ST PO BOX 272
BELOIT WI
53511-6230
US

V. Phone/Fax

Practice location:
  • Phone: 608-856-4424
  • Fax: 608-367-0176
Mailing address:
  • Phone: 847-372-6558
  • Fax: 608-367-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12450125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: