Provider Demographics
NPI:1871134205
Name:ASHLEY, ADRIENNE (BCBA)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E COTTONWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7055
Mailing Address - Country:US
Mailing Address - Phone:360-643-9528
Mailing Address - Fax:
Practice Address - Street 1:2825 E COTTONWOOD PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-7055
Practice Address - Country:US
Practice Address - Phone:360-643-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WA106S00000X
WY1-22-60474103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty