Provider Demographics
NPI:1609421296
Name:BUSH, ASHLEY (LISW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ALBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:112 E DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3366
Mailing Address - Country:US
Mailing Address - Phone:419-575-3490
Mailing Address - Fax:419-715-0776
Practice Address - Street 1:112 E DUDLEY ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3366
Practice Address - Country:US
Practice Address - Phone:419-575-3490
Practice Address - Fax:419-715-0776
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1500813-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical