Healthcare Provider Details

I. General information

NPI: 1073481289
Provider Name (Legal Business Name): ASHLEY WYLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 CLIFTON AVE STE 202
CLIFTON NJ
07013-3650
US

IV. Provider business mailing address

5075 STACEY DR E APT 2510
HARRISBURG PA
17111-5914
US

V. Phone/Fax

Practice location:
  • Phone: 973-210-9040
  • Fax:
Mailing address:
  • Phone: 717-781-3879
  • Fax: 717-781-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00232900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: