Provider Demographics
NPI:1528697471
Name:MEADOWS, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MEADOWS
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 1:1140 MAYROSE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2023
Mailing Address - Country:US
Mailing Address - Phone:937-751-2205
Mailing Address - Fax:
Practice Address - Street 1:1140 MAYROSE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2023
Practice Address - Country:US
Practice Address - Phone:937-689-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2025-04-23
Deactivation Date:2024-01-09
Deactivation Code:
Reactivation Date:2024-01-26
Provider Licenses
StateLicense IDTaxonomies
372500000X, 171WH0202X
OHLICDC.162454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No372500000XNursing Service Related ProvidersChore Provider
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH37Medicaid