Provider Demographics
NPI:1801548011
Name:STACKER, ASHLEY R (LMSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:STACKER
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 1:4805 N COLOMA RD
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-9545
Mailing Address - Country:US
Mailing Address - Phone:269-921-0311
Mailing Address - Fax:
Practice Address - Street 1:4805 N COLOMA RD
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-9545
Practice Address - Country:US
Practice Address - Phone:269-921-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011123781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical