Healthcare Provider Details

I. General information

NPI: 1700475159
Provider Name (Legal Business Name): ASHLEY SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 E 200 N STE 100
AMERICAN FORK UT
84003-2053
US

IV. Provider business mailing address

4608 CADDIE LN
HIGHLAND UT
84003-9553
US

V. Phone/Fax

Practice location:
  • Phone: 336-978-1607
  • Fax:
Mailing address:
  • Phone: 336-978-1607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number13464825-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: