Provider Demographics
NPI:1225301906
Name:PETERSON, ASHLEY M (LPC)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:PERUSHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 N WESTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5715
Mailing Address - Country:US
Mailing Address - Phone:920-750-7000
Mailing Address - Fax:920-364-2415
Practice Address - Street 1:444 N WESTHILL BLVD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5715
Practice Address - Country:US
Practice Address - Phone:920-750-7000
Practice Address - Fax:920-364-2415
Is Sole Proprietor?:No
Enumeration Date:2012-02-11
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101Y00000X
WI5663-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional