Individual
ASHLEY LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 S SWOOPE AVE, SUITE 110, MAITLAND, FL 32751-5784
(407) 968-8349
Mailing address
1716 SUNCREST LOOP, CASSELBERRY, FL 32707
(407) 927-6522
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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