Provider Demographics
NPI:1306395611
Name:HENNON, ASHLIE
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:
Last Name:HENNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 GLENMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2771
Mailing Address - Country:US
Mailing Address - Phone:724-714-6532
Mailing Address - Fax:
Practice Address - Street 1:2104 GLENMOOR DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2771
Practice Address - Country:US
Practice Address - Phone:724-714-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician