Provider Demographics
NPI:1881053106
Name:HAIRL, ASHLEY (LPC-IT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HAIRL
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 CARTER CT
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-2201
Mailing Address - Country:US
Mailing Address - Phone:920-739-3009
Mailing Address - Fax:
Practice Address - Street 1:569 CARTER CT
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2201
Practice Address - Country:US
Practice Address - Phone:920-739-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2907-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2907-226Medicaid