MEDICARE: ASHLEIGH FERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		UT

General Provider Information

NPI Number	:	1952147639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEIGH FERNANDEZ

Provider Business Mailing Address
First Line	:	8539 S REDWOOD RD STE C
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-5250
Country	:	US
Telephone Number	:	385-424-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8539 S REDWOOD RD STE C
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-5250
Country	:	US
Telephone Number	:	385-424-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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Directions to “ ASHLEIGH FERNANDEZ ” Practice Location

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