Provider Demographics
NPI:1508695362
Name:WASILEWSKI, ASHLEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:WASILEWSKI
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 1:330 SHOUP AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3650
Mailing Address - Country:US
Mailing Address - Phone:208-715-7551
Mailing Address - Fax:
Practice Address - Street 1:330 SHOUP AVE STE 206
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3650
Practice Address - Country:US
Practice Address - Phone:208-715-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
ID3061075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist