Healthcare Provider Details

I. General information

NPI: 1063991693
Provider Name (Legal Business Name): ASHLYN VICTORIA RAGER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 E PASS RD
GULFPORT MS
39507-3311
US

IV. Provider business mailing address

111 WARWICK DR
LONG BEACH MS
39560-2638
US

V. Phone/Fax

Practice location:
  • Phone: 228-260-6892
  • Fax: 228-400-9143
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-63193
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: