Provider Demographics
NPI:1912384884
Name:ABBOTT, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ABBOTT
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 1:3815 BRECKINRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9003
Mailing Address - Country:US
Mailing Address - Phone:352-223-1999
Mailing Address - Fax:352-600-3119
Practice Address - Street 1:409 E OAKLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-3070
Practice Address - Country:US
Practice Address - Phone:352-223-1999
Practice Address - Fax:352-600-3119
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst