Provider Demographics
NPI:1649842782
Name:LEBRON, ASHLEY ELISE (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELISE
Last Name:LEBRON
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 1:225 DEVRON CIR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1608
Mailing Address - Country:US
Mailing Address - Phone:309-453-8675
Mailing Address - Fax:
Practice Address - Street 1:1820 N STERLING AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-6433
Practice Address - Country:US
Practice Address - Phone:309-212-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0233331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical