MEDICARE: ASHLEY GOODMAN

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	RBT-25-425656

General Provider Information

NPI Number	:	1588559843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GOODMAN

Provider Business Mailing Address
First Line	:	2177 BROADMOOR ROAD CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3307
Country	:	US
Telephone Number	:	719-216-9943
Fax Number	:

Provider Business Practice Location Address
First Line	:	2177 BROADMOOR ROAD CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3307
Country	:	US
Telephone Number	:	719-216-9943
Fax Number	:

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	03/24/2026

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Directions to “ ASHLEY GOODMAN ” Practice Location

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