Healthcare Provider Details

I. General information

NPI: 1861021461
Provider Name (Legal Business Name): ASHLEY WALTZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY WALTZ BCBA

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4778 OVERTON RD
BIRMINGHAM AL
35210-3803
US

IV. Provider business mailing address

4778 OVERTON RD
BIRMINGHAM AL
35210-3803
US

V. Phone/Fax

Practice location:
  • Phone: 205-957-0294
  • Fax: 205-957-0298
Mailing address:
  • Phone: 205-957-0294
  • Fax: 205-957-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12477181
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-115558
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: