Provider Demographics
NPI:1588202899
Name:BRADSHAW, ASHLIE
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:
Last Name:BRADSHAW
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 1:102 KELLEY CV
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-2226
Mailing Address - Country:US
Mailing Address - Phone:251-648-4346
Mailing Address - Fax:
Practice Address - Street 1:9480 THREE RIVERS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4248
Practice Address - Country:US
Practice Address - Phone:251-648-4346
Practice Address - Fax:888-462-6035
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician