Provider Demographics
NPI:1063037463
Name:ASHBURN, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ASHBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:HANKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58041-0100
Mailing Address - Country:US
Mailing Address - Phone:701-242-7031
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 100
Practice Address - Street 2:
Practice Address - City:HANKINSON
Practice Address - State:ND
Practice Address - Zip Code:58041-0100
Practice Address - Country:US
Practice Address - Phone:701-242-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL94103K00000X
174400000X
ND000424851103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist