Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCSW70676 | CA |
NPI | 1003261454 |
---|---|
Provider Name | Mrs. Jacqueline S Ashley |
First Address | Riverside, CA 92517-0623 |
Second Address | Riverside, CA 92504-4544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2016 |
Last Update Date | 03/05/2016 |