Provider Demographics
NPI:1225476583
Name:GAUCK, ASHLEY A (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:GAUCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:A
Other - Last Name:PULSKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2451 INTELLIPLEX DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8580
Mailing Address - Country:US
Mailing Address - Phone:317-421-1942
Mailing Address - Fax:317-398-1853
Practice Address - Street 1:1626 E STATE RD 44
Practice Address - Street 2:STE A
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-4057
Practice Address - Country:US
Practice Address - Phone:317-421-2012
Practice Address - Fax:317-398-1852
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34007617A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker