Provider Demographics
NPI:1558746784
Name:VAN DUSEN, ASHLEE (RBT)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:VAN DUSEN
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 1:6714 WINKLER RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7204
Mailing Address - Country:US
Mailing Address - Phone:239-245-8301
Mailing Address - Fax:239-245-8731
Practice Address - Street 1:6714 WINKLER RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7204
Practice Address - Country:US
Practice Address - Phone:239-245-8301
Practice Address - Fax:239-245-8731
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-00444103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst