Provider Demographics
NPI:1225725757
Name:PESHEK, ASHLEY SUE NICHOLE
Entity Type:Individual
Prefix:
First Name:ASHLEY SUE
Middle Name:NICHOLE
Last Name:PESHEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY SUE
Other - Middle Name:NICHOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 S DOBSON RD LOT 123
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-2712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 S DOBSON RD LOT 123
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-2712
Practice Address - Country:US
Practice Address - Phone:928-301-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician