Provider Demographics
NPI:1184959371
Name:ASH, SHANNON L (PSYD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:ASH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 HEMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3138
Mailing Address - Country:US
Mailing Address - Phone:970-556-5170
Mailing Address - Fax:
Practice Address - Street 1:6009 HEMPSTEAD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-3138
Practice Address - Country:US
Practice Address - Phone:970-556-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor