Provider Demographics
NPI:1215293287
Name:ANDERSON, ASHLEY K (PSYD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20635 ABBEY WOODS CT. N. SUITE 303-3
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-534-5431
Mailing Address - Fax:779-324-5097
Practice Address - Street 1:20635 ABBEY WOODS CT. N. SUITE 303-3
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:815-534-5431
Practice Address - Fax:779-324-5097
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical