Provider Demographics
NPI:1386236990
Name:LOCKHART, ASHTON RAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ASHTON
Middle Name:RAE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 JONATHAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-2908
Mailing Address - Country:US
Mailing Address - Phone:815-621-3853
Mailing Address - Fax:
Practice Address - Street 1:5301 E STATE ST STE 309A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2399
Practice Address - Country:US
Practice Address - Phone:608-713-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0225641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical