Provider Demographics
NPI:1063028363
Name:FRIZZELL, ASHLEY NICHOLE (LCSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:FRIZZELL
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-2033
Mailing Address - Country:US
Mailing Address - Phone:815-791-2295
Mailing Address - Fax:
Practice Address - Street 1:310 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-2033
Practice Address - Country:US
Practice Address - Phone:815-791-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0159301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical