Provider Demographics
NPI:1528644119
Name:BRICKLES, ASHLEY (MSW, LISW, SAP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRICKLES
Suffix:
Gender:F
Credentials:MSW, LISW, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 BOYD RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9771
Mailing Address - Country:US
Mailing Address - Phone:937-510-8384
Mailing Address - Fax:
Practice Address - Street 1:1196 BOYD RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9771
Practice Address - Country:US
Practice Address - Phone:937-510-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20022351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical