MEDICARE: ASHLEIGH BANKS BCBA, LBA

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	247200000X	Other Technician
2	103K00000X	Behavior Analyst	7401000162	MI

General Provider Information

NPI Number	:	1649627456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEIGH BANKS BCBA, LBA

Provider Business Mailing Address
First Line	:	6129 OLD STATE RD
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-8137
Country	:	US
Telephone Number	:	810-625-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	6129 OLD STATE RD
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-8137
Country	:	US
Telephone Number	:	810-625-3250
Fax Number	:

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

Provider Enumeration Date	:	05/22/2016
Last Update Date	:	06/08/2020

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