Provider Demographics
NPI:1508288515
Name:SEVERSON, ASHLEY N (ASW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19260 WYATT RD
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:490 MENDOCINO AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6393
Practice Address - Country:US
Practice Address - Phone:707-565-7817
Practice Address - Fax:707-565-4881
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW67281104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker