Provider Information for 1154944452
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ASHLEY SPICKLER
Sex: Female
NPI: 1154944452
Last Updated: 2020-05-20
Certification Date: 2020-05-20
Certification Date: 2020-05-20
Details
Name | Value | ||||||||
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NPI | 1154944452 | ||||||||
Enumeration Date | 2020-05-20 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 175 E HAWTHORN PKWY STE 235 VERNON HILLS, IL 60061-1454 United States Phone: 847-868-3435 | Fax:847-859-5885 | ||||||||
Primary Practice Address | 4615 E STATE ST STE 202 ROCKFORD, IL 61108-2158 United States Phone: 847-868-3435 | Fax:847-859-5885 | ||||||||
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