Provider Demographics
NPI:1528897550
Name:FULTON, ASHLEY (MSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FULTON
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 1:4429 S RIVER BLVD STE BC
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4659
Mailing Address - Country:US
Mailing Address - Phone:816-768-0090
Mailing Address - Fax:816-912-1739
Practice Address - Street 1:4429 S RIVER BLVD STE BC
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4659
Practice Address - Country:US
Practice Address - Phone:816-768-0090
Practice Address - Fax:816-912-1739
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13591-T1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty