Provider Demographics
NPI:1467839464
Name:SHEETER, ASHLEY RAE (PSYD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:SHEETER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RAE
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 22040
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2040
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:2820 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3834
Practice Address - Country:US
Practice Address - Phone:920-433-6073
Practice Address - Fax:715-735-5388
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3740-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467839464OtherBOARD CERTIFICATION NATION REGISTER OF HEALTH SERVICE PSYCHOLOGISTS
KY1790731081Medicaid