Provider Demographics
NPI:1487103537
Name:FULLENKAMP, ASHTON (LISW)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:FULLENKAMP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:
Other - Last Name:KINDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1490 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3305
Mailing Address - Country:US
Mailing Address - Phone:513-881-7189
Mailing Address - Fax:513-881-7188
Practice Address - Street 1:8736 EDGERIDGE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3242
Practice Address - Country:US
Practice Address - Phone:937-407-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical