Provider Demographics
NPI:1407494032
Name:MILLER, ASHLEY ANN (RBT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5408
Mailing Address - Country:US
Mailing Address - Phone:765-282-8222
Mailing Address - Fax:765-282-2820
Practice Address - Street 1:4129 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-8115
Practice Address - Country:US
Practice Address - Phone:708-722-2384
Practice Address - Fax:708-563-2125
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARBT-19-104793106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician