Provider Demographics
NPI:1396434205
Name:BANTA, ASHLEY GLORIA (MA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GLORIA
Last Name:BANTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2340 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5702
Mailing Address - Country:US
Mailing Address - Phone:515-235-5224
Mailing Address - Fax:866-672-0706
Practice Address - Street 1:2340 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5702
Practice Address - Country:US
Practice Address - Phone:515-235-5224
Practice Address - Fax:866-672-0706
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1035633101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool