Provider Demographics
NPI:1588215321
Name:HENDRICKSON, ASHLEY JORDAN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JORDAN
Last Name:HENDRICKSON
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 1:15515 JUANITA WOODINVILLE WAY NE UNIT I103
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1599
Mailing Address - Country:US
Mailing Address - Phone:425-516-2484
Mailing Address - Fax:
Practice Address - Street 1:632 182ND ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6275
Practice Address - Country:US
Practice Address - Phone:425-246-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty