Provider Demographics
NPI:1043822687
Name:WILLACKER, ASHLEY J
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:WILLACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:J
Other - Last Name:MERROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8966 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8604
Mailing Address - Country:US
Mailing Address - Phone:989-255-9025
Mailing Address - Fax:
Practice Address - Street 1:8966 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8604
Practice Address - Country:US
Practice Address - Phone:989-255-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker