Provider Demographics
NPI:1669712600
Name:WALLS, ASHLEY (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WALLS
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 1:8950 SW 74TH CT
Mailing Address - Street 2:STE 2201-#A-133
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3181
Mailing Address - Country:US
Mailing Address - Phone:305-773-8199
Mailing Address - Fax:
Practice Address - Street 1:8950 SW 74TH CT
Practice Address - Street 2:STE 2201-#A-133
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3181
Practice Address - Country:US
Practice Address - Phone:305-773-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X, 222Q00000X, 390200000X
FL1-18-30837103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program