Provider Demographics
NPI:1790416667
Name:HARTELL, ASHLEY PATRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PATRICIA
Last Name:HARTELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 BUCK AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-2710
Mailing Address - Country:US
Mailing Address - Phone:708-275-2144
Mailing Address - Fax:
Practice Address - Street 1:3632 BUCK AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-2710
Practice Address - Country:US
Practice Address - Phone:708-275-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490216281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical