Provider Demographics
NPI:1174994727
Name:CALLSTROM, ASHLEY D (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:D
Last Name:CALLSTROM
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 1:4155 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3725
Mailing Address - Country:US
Mailing Address - Phone:316-831-0330
Mailing Address - Fax:316-831-9569
Practice Address - Street 1:4155 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3725
Practice Address - Country:US
Practice Address - Phone:316-831-0330
Practice Address - Fax:316-831-9569
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker