Provider Demographics
NPI:1518405646
Name:CHANNELL, ASHLEE KYLER
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:KYLER
Last Name:CHANNELL
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 1:360 ARORA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3264
Mailing Address - Country:US
Mailing Address - Phone:904-672-0106
Mailing Address - Fax:
Practice Address - Street 1:360 ARORA BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3264
Practice Address - Country:US
Practice Address - Phone:904-672-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst