Provider Demographics
NPI:1912139882
Name:EHRENSTROM, ASHLEY (MED, EDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:EHRENSTROM
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16066 N PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7461
Mailing Address - Country:US
Mailing Address - Phone:623-556-5963
Mailing Address - Fax:
Practice Address - Street 1:16066 N PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7461
Practice Address - Country:US
Practice Address - Phone:623-523-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4220161103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool