Provider Demographics
NPI:1306647748
Name:SULLIVAN, ASHLYNN (CBT)
Entity type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 S MAIN ST APT 15
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4242
Mailing Address - Country:US
Mailing Address - Phone:208-916-6576
Mailing Address - Fax:
Practice Address - Street 1:1410 NE STADIUM WAY
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-4619
Practice Address - Country:US
Practice Address - Phone:509-332-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician