Individual
ASHLEY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3418 TYLER AVE, OGDEN, UT 84403-1355
(801) 710-5128
Mailing address
3418 TYLER AVE, OGDEN, UT 84403-1355
(801) 710-5128
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RA59424306
BLUE CROSS BLUE SHIELD
UT
Enumeration date
01/27/2021
Last updated
01/27/2021
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