Provider Demographics
NPI:1891981387
Name:SOVEREIGN, ASHLEY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:SOVEREIGN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:SOVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:366 SELBY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1880
Mailing Address - Country:US
Mailing Address - Phone:612-245-8745
Mailing Address - Fax:
Practice Address - Street 1:366 SELBY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1880
Practice Address - Country:US
Practice Address - Phone:612-245-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist