Provider Demographics
NPI:1427809052
Name:SHAW, AINSLEY M
Entity type:Individual
Prefix:
First Name:AINSLEY
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10298 S OTTER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-6109
Mailing Address - Country:US
Mailing Address - Phone:801-317-7996
Mailing Address - Fax:
Practice Address - Street 1:10298 S OTTER TRAIL DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-6109
Practice Address - Country:US
Practice Address - Phone:801-317-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician