Provider Demographics
NPI:1003271693
Name:BIRKHOLZ, ASHLEY ELIZABETH (CAPSW, SAC)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:BIRKHOLZ
Suffix:
Gender:F
Credentials:CAPSW, SAC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:CZARNOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1626 CLARENCE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-8533
Mailing Address - Country:US
Mailing Address - Phone:262-338-8611
Mailing Address - Fax:262-338-3367
Practice Address - Street 1:1626 CLARENCE CT
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-8533
Practice Address - Country:US
Practice Address - Phone:262-338-8611
Practice Address - Fax:262-338-3367
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)