Provider Demographics
NPI:1104644152
Name:BRAGG, ASHLEY (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WEED KELTNER RD
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8814
Mailing Address - Country:US
Mailing Address - Phone:270-634-4377
Mailing Address - Fax:
Practice Address - Street 1:2465 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4510
Practice Address - Country:US
Practice Address - Phone:606-677-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst