Provider Demographics
NPI:1174172449
Name:GRAEF, ASHLEY (ASUDC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GRAEF
Suffix:
Gender:F
Credentials:ASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5703
Mailing Address - Country:US
Mailing Address - Phone:415-250-5959
Mailing Address - Fax:
Practice Address - Street 1:4905 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5703
Practice Address - Country:US
Practice Address - Phone:415-250-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12514799-6018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1174172449Medicaid