Healthcare Provider Details

I. General information

NPI: 1306297270
Provider Name (Legal Business Name): ASHLEY E CORTEZ MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 DRESSER DR
JANESVILLE WI
53546-9160
US

IV. Provider business mailing address

4700 DRESSER DR
JANESVILLE WI
53546-9160
US

V. Phone/Fax

Practice location:
  • Phone: 608-752-7255
  • Fax: 608-752-6942
Mailing address:
  • Phone: 608-752-6942
  • Fax: 608-752-6942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130213
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: