Provider Demographics
NPI:1003250804
Name:WOMBACHER, ASHLEY CAROLINE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAROLINE
Last Name:WOMBACHER
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 1:350 N MAIN ST
Mailing Address - Street 2:P.O. BOX 218
Mailing Address - City:HOYLETON
Mailing Address - State:IL
Mailing Address - Zip Code:62803-2006
Mailing Address - Country:US
Mailing Address - Phone:618-493-7382
Mailing Address - Fax:618-493-6390
Practice Address - Street 1:350 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOYLETON
Practice Address - State:IL
Practice Address - Zip Code:62803-2006
Practice Address - Country:US
Practice Address - Phone:618-493-7382
Practice Address - Fax:618-493-6390
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid