Provider Demographics
NPI:1811533573
Name:SOBERG, ASHLEE ALYSSA ACHTENBERG (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:ALYSSA ACHTENBERG
Last Name:SOBERG
Suffix:
Gender:
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 GRIFFON TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7222
Mailing Address - Country:US
Mailing Address - Phone:651-707-4376
Mailing Address - Fax:
Practice Address - Street 1:16311 GRIFFON TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7222
Practice Address - Country:US
Practice Address - Phone:651-707-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI508-140103K00000X
MNLBA0482103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst