Healthcare Provider Details

I. General information

NPI: 1962063230
Provider Name (Legal Business Name): AMBER KATHLEEN ASHBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 09/20/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 S 1470 E STE 201
ST GEORGE UT
84790-2762
US

IV. Provider business mailing address

254 S 1470 E STE 201
ST GEORGE UT
84790-2762
US

V. Phone/Fax

Practice location:
  • Phone: 435-932-3672
  • Fax:
Mailing address:
  • Phone: 435-932-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: