Provider Demographics
NPI:1790285351
Name:REYNOLDS, ASHLEIGH (BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:CA
Mailing Address - Zip Code:95439-0104
Mailing Address - Country:US
Mailing Address - Phone:707-303-6266
Mailing Address - Fax:
Practice Address - Street 1:2323 VENNIE CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4998
Practice Address - Country:US
Practice Address - Phone:707-303-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11727135103K00000X
CA1-17-27135103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst