Healthcare Provider Details

I. General information

NPI: 1871086363
Provider Name (Legal Business Name): ASHLEY TAYLOR GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date: 03/23/2026
Reactivation Date: 03/31/2026

III. Provider practice location address

88 E 1000 N
TOOELE UT
84074-9693
US

IV. Provider business mailing address

88 E 1000 N
TOOELE UT
84074-9693
US

V. Phone/Fax

Practice location:
  • Phone: 435-249-0934
  • Fax: 435-608-3131
Mailing address:
  • Phone: 435-249-0934
  • Fax: 435-608-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15750
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: