Healthcare Provider Details

I. General information

NPI: 1841862034
Provider Name (Legal Business Name): ASHLEY D WEDDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 W CENTER ST
PLEASANT GROVE UT
84062-2215
US

IV. Provider business mailing address

117 N 1185 E
PLEASANT GROVE UT
84062-2543
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-7775
  • Fax:
Mailing address:
  • Phone: 614-359-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: