Provider Demographics
NPI:1184392748
Name:NEAL, ASHLEY ANNE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANNE
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 GINGOTEAGUE WAY
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6392
Mailing Address - Country:US
Mailing Address - Phone:309-202-3107
Mailing Address - Fax:
Practice Address - Street 1:1808 GINGOTEAGUE WAY
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6392
Practice Address - Country:US
Practice Address - Phone:309-202-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool