Healthcare Provider Details

I. General information

NPI: 1013726678
Provider Name (Legal Business Name): ASHLEY LOREN BUCKMASTER APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAIN ST
PORT WASHINGTON WI
53074-1813
US

IV. Provider business mailing address

121 W MAIN ST
PORT WASHINGTON WI
53074-1813
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-8200
  • Fax:
Mailing address:
  • Phone: 715-891-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number135276-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: