Provider Demographics
NPI:1952967630
Name:DEGENFELDER, ASHLI NICHOLE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLI
Middle Name:NICHOLE
Last Name:DEGENFELDER
Suffix:
Gender:F
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 1:239 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5821
Mailing Address - Country:US
Mailing Address - Phone:765-242-4196
Mailing Address - Fax:
Practice Address - Street 1:1389 W 86TH ST # 170
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2101
Practice Address - Country:US
Practice Address - Phone:317-409-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-19-34747103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst