MEDICARE: ASHLEY NICOLE VANHOOSE 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	257743	KY

General Provider Information

NPI Number	:	1972259356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE VANHOOSE LCSW

Provider Business Mailing Address
First Line	:	142 SPENCER LN
Second Line	:
City	:	CLAY CITY
State	:	KY
Zip	:	40312-9722
Country	:	US
Telephone Number	:	606-481-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2174
Country	:	US
Telephone Number	:	606-284-6674
Fax Number	:

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

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	04/15/2023

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