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NPI Code Detail

MEDICARE: ALYSSA JEAN ASHBURN BCBA, LBA, QSP

MEDICARE: ALYSSA JEAN ASHBURN BCBA, LBA, QSP
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 AnalystLBA0395MN

General Provider Information

NPI Number : 1477273571
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA JEAN ASHBURN BCBA, LBA, QSP
Provider Business Mailing Address
First Line : 1301 MILLER TRUNK HWY STE 500
Second Line :
City : DULUTH
State : MN
Zip : 55811-5644
Country : US
Telephone Number : 218-481-7290
Fax Number : 218-481-7263
Provider Business Practice Location Address
First Line : 1301 MILLER TRUNK HWY STE 500
Second Line :
City : DULUTH
State : MN
Zip : 55811-5644
Country : US
Telephone Number : 218-481-7290
Fax Number : 218-481-7263
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2022
Last Update Date : 05/21/2026

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