Provider Demographics
NPI:1790259877
Name:ASHLAND, LISA R (AA, BA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:ASHLAND
Suffix:
Gender:F
Credentials:AA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ZINNIA ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3934
Mailing Address - Country:US
Mailing Address - Phone:307-247-2655
Mailing Address - Fax:
Practice Address - Street 1:328 ZINNIA ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3934
Practice Address - Country:US
Practice Address - Phone:307-247-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management