MEDICARE: ASHTEN ZUEHLSDORFF

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
1	106S00000X	Behavior Technician	RBT120941	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT120941	OTHER	WY	BACB

General Provider Information

NPI Number	:	1154945400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHTEN ZUEHLSDORFF

Provider Business Mailing Address
First Line	:	2632 FOOTHILL BLVD
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 FOOTHILL BLVD
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4756
Country	:	US
Telephone Number	:	307-705-3004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	06/02/2020

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Directions to “ ASHTEN ZUEHLSDORFF ” Practice Location

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