Provider Demographics
NPI:1417580648
Name:BLOODWORTH, ASHLEY K (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:K
Last Name:BLOODWORTH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7744 NORTHCROSS DR APT N160
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1733
Mailing Address - Country:US
Mailing Address - Phone:512-699-3968
Mailing Address - Fax:
Practice Address - Street 1:2100 KRAMER LN STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4094
Practice Address - Country:US
Practice Address - Phone:512-572-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3269103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst