MEDICARE: ASHLEA KROUSE 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	103K00000X	Behavior Analyst	0133000471	VA

General Provider Information

NPI Number	:	1679944391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEA KROUSE BCBA, LBA

Provider Business Mailing Address
First Line	:	2708 PARKWOOD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-5114
Country	:	US
Telephone Number	:	804-201-9772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 PARKWOOD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-5114
Country	:	US
Telephone Number	:	804-201-9772
Fax Number	:

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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