Provider Demographics
NPI:1689006421
Name:ROBERTS, ASHLEY NICHOLE (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:NICHOLE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, BCABA
Mailing Address - Street 1:8282 28TH CT NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-7162
Mailing Address - Country:US
Mailing Address - Phone:360-915-6868
Mailing Address - Fax:
Practice Address - Street 1:8282 28TH CT NE
Practice Address - Street 2:SUITE A
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-7162
Practice Address - Country:US
Practice Address - Phone:360-915-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-18-32740103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst