Provider Demographics
NPI:1467928655
Name:KOPP, ASHLEY JEAN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEAN
Last Name:KOPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-0035
Mailing Address - Country:US
Mailing Address - Phone:573-680-1390
Mailing Address - Fax:
Practice Address - Street 1:214 ELM ST STE 207
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-2340
Practice Address - Country:US
Practice Address - Phone:573-680-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO20180292421041C0700X
MO20180292421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical