Healthcare Provider Details

I. General information

NPI: 1497602957
Provider Name (Legal Business Name): ASHLEY HEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W10766 UPPER RED LAKE RD
GRESHAM WI
54128-9126
US

IV. Provider business mailing address

W10766 UPPER RED LAKE RD
GRESHAM WI
54128-9126
US

V. Phone/Fax

Practice location:
  • Phone: 715-799-3835
  • Fax:
Mailing address:
  • Phone: 715-799-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPAR-0000815361
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: