Provider Demographics
NPI:1184228660
Name:RHOADS, ASHLEY (LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RHOADS
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1620
Mailing Address - Country:US
Mailing Address - Phone:218-591-1068
Mailing Address - Fax:218-499-7001
Practice Address - Street 1:1102 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1620
Practice Address - Country:US
Practice Address - Phone:218-591-1068
Practice Address - Fax:218-499-7001
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305089101YA0400X
MN256611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)