Provider Demographics
NPI:1649916206
Name:GIBBS, ASHLEY TAYLOR
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TAYLOR
Last Name:GIBBS
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 1:1605 W JAMES LN APT 2I01
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4351
Mailing Address - Country:US
Mailing Address - Phone:425-478-6622
Mailing Address - Fax:
Practice Address - Street 1:5410 194TH AVE SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8626
Practice Address - Country:US
Practice Address - Phone:425-375-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61281154106S00000X
WAAB61608372106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician