Provider Demographics
NPI:1619693728
Name:O'CONNOR, ASHLEY (PHD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 TUDOR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1643
Mailing Address - Country:US
Mailing Address - Phone:907-297-9858
Mailing Address - Fax:
Practice Address - Street 1:3211 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4645
Practice Address - Country:US
Practice Address - Phone:907-297-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0208131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical