Basic Information
| Provider Information | |||||||||
| NPI: | 1154795029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUCK | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MSSW, CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10100 ELIDA RD | ||||||||
| Address2: | |||||||||
| City: | DELPHOS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458339056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196958010 | ||||||||
| FaxNumber: | 4196950565 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 N DIXIE HWY | ||||||||
| Address2: | STE 6 | ||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427014649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707661397 | ||||||||
| FaxNumber: | 2707359848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2015 | ||||||||
| LastUpdateDate: | 11/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7454 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.