Provider Demographics
NPI:1619318979
Name:TILLERY, ASHLEY ANN (LMFT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:TILLERY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 W STATE ROAD 59
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9418
Mailing Address - Country:US
Mailing Address - Phone:715-572-5362
Mailing Address - Fax:
Practice Address - Street 1:1173 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1672
Practice Address - Country:US
Practice Address - Phone:262-458-2525
Practice Address - Fax:262-458-2680
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11800-120104100000X
WI1170-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker