Provider Demographics
NPI:1801368261
Name:PETHTEL, ASHLIE (CDCA QMHS LSW MSW)
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:
Last Name:PETHTEL
Suffix:
Gender:F
Credentials:CDCA QMHS LSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E. LIBERTY ST. WOOSTER, OHIO 44691
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691
Mailing Address - Country:US
Mailing Address - Phone:330-636-6324
Mailing Address - Fax:
Practice Address - Street 1:127 EAST LIBERTY STREET WOOSTER, OHIO
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691
Practice Address - Country:US
Practice Address - Phone:330-636-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.170944101YA0400X
OH171M00000X
OHS.21067071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator