Provider Demographics
NPI:1750115069
Name:KERSTEN, ASHLEY (LSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KERSTEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S ELIDA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-9706
Mailing Address - Country:US
Mailing Address - Phone:815-985-1484
Mailing Address - Fax:
Practice Address - Street 1:555 S PERRYVILLE RD STE 222
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2527
Practice Address - Country:US
Practice Address - Phone:815-331-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker