Provider Demographics
NPI:1649530205
Name:KENWORTHY, ASHLEE (LMSW)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:KENWORTHY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 WILTSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3318
Mailing Address - Country:US
Mailing Address - Phone:248-417-9705
Mailing Address - Fax:
Practice Address - Street 1:5111 AUTO CLUB DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2749
Practice Address - Country:US
Practice Address - Phone:313-317-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010866761041C0700X
NV5375-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical