Provider Demographics
NPI:1922835917
Name:KASHEVAROFF, ASHLEY RAE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:KASHEVAROFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 120TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-6200
Mailing Address - Country:US
Mailing Address - Phone:612-850-5567
Mailing Address - Fax:
Practice Address - Street 1:19580 STATION ST
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-9411
Practice Address - Country:US
Practice Address - Phone:612-850-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)