Healthcare Provider Details

I. General information

NPI: 1649916206
Provider Name (Legal Business Name): ASHLEY TAYLOR GIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 194TH AVE SE
ISSAQUAH WA
98027-8626
US

IV. Provider business mailing address

1605 W JAMES LN APT 2I01
KENT WA
98032-4351
US

V. Phone/Fax

Practice location:
  • Phone: 425-375-7665
  • Fax:
Mailing address:
  • Phone: 425-478-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61608372
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61281154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: