Provider Demographics
NPI:1023457504
Name:SHAMBLIN, ASHLEY (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1504
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-1504
Mailing Address - Country:US
Mailing Address - Phone:541-973-1361
Mailing Address - Fax:
Practice Address - Street 1:13797 E EVANS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9778
Practice Address - Country:US
Practice Address - Phone:541-973-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2024-03-29
Deactivation Date:2024-02-26
Deactivation Code:
Reactivation Date:2024-03-28
Provider Licenses
StateLicense IDTaxonomies
ORL116021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical