Provider Demographics
NPI:1235607300
Name:THIELMAN, ASHLEY NICHOLE (LISW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:THIELMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25940 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9786
Mailing Address - Country:US
Mailing Address - Phone:419-481-0806
Mailing Address - Fax:
Practice Address - Street 1:4334 W CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1679
Practice Address - Country:US
Practice Address - Phone:419-318-3818
Practice Address - Fax:877-927-2984
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22041581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221379Medicaid