Healthcare Provider Details

I. General information

NPI: 1710622642
Provider Name (Legal Business Name): ASHLEY AMBER BOSTWICK MS, ATR-P, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 LATHAM DR
MADISON WI
53713-4613
US

IV. Provider business mailing address

3101 LATHAM DR
MADISON WI
53713-4613
US

V. Phone/Fax

Practice location:
  • Phone: 608-286-1132
  • Fax:
Mailing address:
  • Phone: 608-286-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5314226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: