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General NPI Number Information
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NPI Number | 1811533573
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Entity Type | Individual
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Provider Name | ASHLEE ALYSSA ACHTENBERG SOBERG MA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 16311 GRIFFON TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-7222
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Country | US
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Telephone | 651-707-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 16311 GRIFFON TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-7222
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Country | US
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Telephone | 651-707-4376
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 508-140
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA0482
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License Number State | MN
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