MEDICARE: ASHLEY VONGREY, LMSW, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114760196	OTHER	MI	NPPES

General Provider Information

NPI Number	:	1851136774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY VONGREY, LMSW, LLC

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	AUBURN
State	:	MI
Zip	:	48611-0424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 MIDLAND RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9455
Country	:	US
Telephone Number	:	989-450-6061
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY VONGREY
Credential	:	LMSW-C
Telephone Number	:	989-450-6061

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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