Healthcare Provider Details

I. General information

NPI: 1265937577
Provider Name (Legal Business Name): LAURA ASHLEY HENDRICKS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 PALOMAR AIRPT RD STE 350
CARLSBAD CA
92011-1451
US

IV. Provider business mailing address

2344 BLOM ST
SAN DIEGO CA
92109-3732
US

V. Phone/Fax

Practice location:
  • Phone: 760-438-0078
  • Fax:
Mailing address:
  • Phone: 443-545-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: