Provider Demographics
NPI:1073998084
Name:BRADLEY, ASHLEY (BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:HOSKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8016 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8751
Mailing Address - Country:US
Mailing Address - Phone:904-329-3317
Mailing Address - Fax:904-329-3318
Practice Address - Street 1:8016 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8751
Practice Address - Country:US
Practice Address - Phone:904-329-3317
Practice Address - Fax:904-329-3318
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-18719103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst