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NPI Code Detail

MEDICARE: SHANNON PAIGE ASH BCBA

MEDICARE: SHANNON PAIGE ASH BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst3543TX

General Provider Information

NPI Number : 1134739097
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON PAIGE ASH BCBA
Provider Business Mailing Address
First Line : 9609 CHOLLA CACTUS TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-7202
Country : US
Telephone Number : 817-845-1629
Fax Number :
Provider Business Practice Location Address
First Line : 608 E HICKORY ST STE 128
Second Line :
City : DENTON
State : TX
Zip : 76205-4311
Country : US
Telephone Number : 940-222-8556
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2020
Last Update Date : 03/26/2021

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