Provider Demographics
NPI:1912368994
Name:GALLICK-SOKOL, ASHLEY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GALLICK-SOKOL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 STARFIRE DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1693
Mailing Address - Country:US
Mailing Address - Phone:815-434-4382
Mailing Address - Fax:815-431-5298
Practice Address - Street 1:1207 STARFIRE DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1693
Practice Address - Country:US
Practice Address - Phone:815-434-4382
Practice Address - Fax:815-431-5298
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014260363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health