Provider Demographics
NPI:1780310805
Name:GLASS, ASHLEY MARY HAMILTON
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARY HAMILTON
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARY
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MSW
Mailing Address - Street 1:3921 S ANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1713
Mailing Address - Country:US
Mailing Address - Phone:707-480-9828
Mailing Address - Fax:
Practice Address - Street 1:3921 S ANGELINE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1713
Practice Address - Country:US
Practice Address - Phone:707-480-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610262281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical