Provider Demographics
NPI:1538995428
Name:ASHFORD, ANNA L (EDS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:ASHFORD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3541
Mailing Address - Country:US
Mailing Address - Phone:219-928-8466
Mailing Address - Fax:
Practice Address - Street 1:163 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3541
Practice Address - Country:US
Practice Address - Phone:219-928-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1557149103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool