Individual
ASHLEE HERBOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1718 N 2525TH RD, OTTAWA, IL 61350
(815) 434-0737
Mailing address
1718 N 2525TH RD, OTTAWA, IL 61350-9329
(815) 434-0737
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/05/2015
Last updated
07/24/2018
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