Provider Demographics
NPI:1285118414
Name:WALSH, ASHLEY MARIE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:15128 SOUTH LA GRANGE RD. P.O. BOX 2032
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-770-9846
Mailing Address - Fax:
Practice Address - Street 1:14234 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1123
Practice Address - Country:US
Practice Address - Phone:708-770-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst