Provider Demographics
NPI:1902139827
Name:KNESEK, ASHLYN PYFER (PSYD HSPP)
Entity Type:Individual
Prefix:DR
First Name:ASHLYN
Middle Name:PYFER
Last Name:KNESEK
Suffix:
Gender:F
Credentials:PSYD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RIDGE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1726
Mailing Address - Country:US
Mailing Address - Phone:219-228-7630
Mailing Address - Fax:
Practice Address - Street 1:900 RIDGE RD
Practice Address - Street 2:SUITE F
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1726
Practice Address - Country:US
Practice Address - Phone:219-228-7630
Practice Address - Fax:219-228-1083
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042885A103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100047140OtherMEDICARE GROUP ID