Provider Demographics
NPI:1477097723
Name:CLEMENT, ASHLEY (MED, BCBA, COBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 WOODMONT RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4324
Mailing Address - Country:US
Mailing Address - Phone:419-304-3264
Mailing Address - Fax:
Practice Address - Street 1:2040 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3946
Practice Address - Country:US
Practice Address - Phone:419-291-7080
Practice Address - Fax:419-480-5901
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst