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General NPI Number Information
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NPI Number | 1609580729
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Entity Type | Individual
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Provider Name | ASHLYN GRACE HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 1061 SMALTZ WAY
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City | AUBURN
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State | IN
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Zip | 46706-9599
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Country | US
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Telephone | 260-255-3665
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Fax |
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Provider Business Mailing Address
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Address Line | 3280 S 390 W
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City | PLEASANT LAKE
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State | IN
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Zip | 46779-9796
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Country | US
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Telephone | 260-667-0572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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