Provider Demographics
NPI:1821334624
Name:KEUNEKE, ASHLEE (BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:KEUNEKE
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 10343
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46851-0343
Mailing Address - Country:US
Mailing Address - Phone:888-667-1181
Mailing Address - Fax:888-265-7858
Practice Address - Street 1:2270 LAKE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5359
Practice Address - Country:US
Practice Address - Phone:888-667-1181
Practice Address - Fax:888-265-7858
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst