Provider Demographics
NPI:1851926141
Name:HARDY, ASHLEY MARIE COOPER
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE COOPER
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:242 W COOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-2106
Mailing Address - Country:US
Mailing Address - Phone:608-669-6143
Mailing Address - Fax:
Practice Address - Street 1:242 W COOK ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2106
Practice Address - Country:US
Practice Address - Phone:608-669-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator