Provider Demographics
NPI:1255097960
Name:VANOPSTALL, ASHLEY (PSYD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:VANOPSTALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 GABRIELLE LN APT 924
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7988
Mailing Address - Country:US
Mailing Address - Phone:810-410-8330
Mailing Address - Fax:
Practice Address - Street 1:1650 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2373
Practice Address - Country:US
Practice Address - Phone:630-283-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical