Provider Demographics
NPI:1710546072
Name:BOONE, ASHLEIGH (MED, EDS)
Entity type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 HAVEN HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-202-6095
Mailing Address - Fax:
Practice Address - Street 1:8910 GREENEWAY COMMONS PL STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4065
Practice Address - Country:US
Practice Address - Phone:502-822-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10247590103TS0200X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY247934OtherLICENSED PSYCHOLOGICAL ASSOCIATE