Provider Demographics
NPI:1528504164
Name:ASHLEY, LEANNA LYN (MSW)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:LYN
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 TIETON DR STE C
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-9750
Practice Address - Street 1:2139 VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2746
Practice Address - Country:US
Practice Address - Phone:509-946-4645
Practice Address - Fax:509-946-1398
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60713857101YM0800X
WALW608964111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2091881Medicaid