Provider Demographics
NPI:1881024842
Name:HENDRICKS, ASHLEY ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WORDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOPELAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2248
Mailing Address - Country:US
Mailing Address - Phone:732-609-4560
Mailing Address - Fax:
Practice Address - Street 1:61 COLONIAL RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2525
Practice Address - Country:US
Practice Address - Phone:973-595-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00100400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist