Provider Demographics
NPI:1922658152
Name:JOHNSON, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:JOHNSON
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 1:276 GRAYLYN CREST DR
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-9418
Mailing Address - Country:US
Mailing Address - Phone:570-523-6787
Mailing Address - Fax:
Practice Address - Street 1:900 BUFFALO RD STE 1
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1206
Practice Address - Country:US
Practice Address - Phone:570-523-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA272112814Medicaid