Healthcare Provider Details

I. General information

NPI: 1831784099
Provider Name (Legal Business Name): ASHLEY LIANE CIMINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N FORT LN APT 105A
LAYTON UT
84041-3409
US

IV. Provider business mailing address

1474 RUBY WAY
SYRACUSE UT
84075-9496
US

V. Phone/Fax

Practice location:
  • Phone: 801-332-9201
  • Fax:
Mailing address:
  • Phone: 928-245-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14280226-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-08090T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: