1336177062 NPI number — MRS. ASHLEY ARMSTRONG DUTROW LCSW

Table of content: MRS. ASHLEY ARMSTRONG DUTROW LCSW (NPI 1336177062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336177062 NPI number — MRS. ASHLEY ARMSTRONG DUTROW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUTROW
Provider First Name:
ASHLEY
Provider Middle Name:
ARMSTRONG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNEILL
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
ARMSTRONG
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336177062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1217 EASTERN PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40204-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-642-6141
Provider Business Mailing Address Fax Number:
502-495-7816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 BRECKENRIDGE LN
Provider Second Line Business Practice Location Address:
115
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40218-4082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-495-7800
Provider Business Practice Location Address Fax Number:
502-495-7816
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  4054 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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