Healthcare Provider Details

I. General information

NPI: 1790697936
Provider Name (Legal Business Name): ASHLEY WYATT PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 BALLS FERRY RD
ANDERSON CA
96007-3537
US

IV. Provider business mailing address

2770 BALLS FERRY RD
ANDERSON CA
96007-3537
US

V. Phone/Fax

Practice location:
  • Phone: 530-378-7000
  • Fax: 530-378-7031
Mailing address:
  • Phone: 530-378-7000
  • Fax: 530-378-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250100586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: