Provider Demographics
NPI:1194272419
Name:JAKEL, ASHLEY VIRGINIA ANN (MSW, LCSW, SAC-IT)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:VIRGINIA ANN
Last Name:JAKEL
Suffix:
Gender:F
Credentials:MSW, LCSW, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6520 LUMBERJACK GUY RD
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5405
Mailing Address - Country:US
Mailing Address - Phone:715-284-9851
Mailing Address - Fax:715-284-5150
Practice Address - Street 1:N6520 LUMBERJACK GUY RD
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5405
Practice Address - Country:US
Practice Address - Phone:715-284-9851
Practice Address - Fax:715-284-3434
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91101041C0700X
WI18634101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100060771Medicaid