Provider Demographics
NPI:1265863153
Name:LYLE, ASHLEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N KNOXVILLE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3005
Mailing Address - Country:US
Mailing Address - Phone:309-495-8679
Mailing Address - Fax:
Practice Address - Street 1:2011 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-2414
Practice Address - Country:US
Practice Address - Phone:309-687-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker