Provider Demographics
NPI:1821300203
Name:SHIPLEY, ANN L (BCBA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:SHIPLEY
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 1:364 E WEBER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1425
Mailing Address - Country:US
Mailing Address - Phone:614-619-7466
Mailing Address - Fax:
Practice Address - Street 1:2500 MEDARY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-2643
Practice Address - Country:US
Practice Address - Phone:614-262-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1-10-6808OtherBEHAVIOR ANALYST CERTIFICATION BOARD