MEDICARE: ASHLEY WILKINS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.021147	IL
2	1041C0700X	Clinical Social Worker	L8564	OR

General Provider Information

NPI Number	:	1265994776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY WILKINS LCSW

Provider Business Mailing Address
First Line	:	10940 SW BARNES RD # 288
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14612 NW OLIVE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-6978
Country	:	US
Telephone Number	:	971-389-4790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	07/07/2023

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Directions to “ ASHLEY WILKINS LCSW” Practice Location

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