Healthcare Provider Details

I. General information

NPI: 1770494031
Provider Name (Legal Business Name): ASHLEY ANN RUDD LSUDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 EXPRESSWAY LN
SPANISH FORK UT
84660-1333
US

IV. Provider business mailing address

1291 EXPRESSWAY LN
SPANISH FORK UT
84660-1333
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-0394
  • Fax:
Mailing address:
  • Phone: 801-367-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14304286-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: