Provider Demographics
NPI:1497958920
Name:ASHLOCK, ALETA S
Entity Type:Individual
Prefix:
First Name:ALETA
Middle Name:S
Last Name:ASHLOCK
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:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:KS
Mailing Address - Zip Code:67428-0223
Mailing Address - Country:US
Mailing Address - Phone:620-628-4677
Mailing Address - Fax:620-628-4461
Practice Address - Street 1:401 S SECOND
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:KS
Practice Address - Zip Code:67428-0223
Practice Address - Country:US
Practice Address - Phone:620-628-4677
Practice Address - Fax:620-628-4461
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor