Provider Demographics
NPI:1417475237
Name:NEESAM-ABUSHHIWA, ASHLEIGH RAE
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:RAE
Last Name:NEESAM-ABUSHHIWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5175 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:PARDEEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53954-9418
Mailing Address - Country:US
Mailing Address - Phone:608-617-0410
Mailing Address - Fax:608-429-3996
Practice Address - Street 1:6502 GRAND TETON PLZ STE 204
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1047
Practice Address - Country:US
Practice Address - Phone:608-338-1786
Practice Address - Fax:608-831-4383
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3944101YP2500X
WI6617-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional