Healthcare Provider Details

I. General information

NPI: 1720791130
Provider Name (Legal Business Name): ASHLEY GILLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 NIKE DR
HILLIARD OH
43026-9081
US

IV. Provider business mailing address

1524 SUNSET BLVD STE A
STEUBENVILLE OH
43952-1380
US

V. Phone/Fax

Practice location:
  • Phone: 800-691-6113
  • Fax:
Mailing address:
  • Phone: 740-264-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-224206
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: