Organization
CITIED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHTON RAE LOCKHART (SOLE PROPRIETOR)
(608) 713-3454
Entity
Organization
Contact information
Practice address
5301 E STATE ST STE 309A, ROCKFORD, IL 61108-2399
(608) 713-3454
Mailing address
1907 JONATHAN AVE, ROCKFORD, IL 61103-2908
(815) 621-3853
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/05/2023
Last updated
10/19/2023
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