Provider Demographics
NPI:1962201236
Name:DIETZ, ASHLEY ROSE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSE
Last Name:DIETZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 DUANE PLZ APT J
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6500
Mailing Address - Country:US
Mailing Address - Phone:402-216-6540
Mailing Address - Fax:
Practice Address - Street 1:2832 DUANE PLZ APT J
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-6500
Practice Address - Country:US
Practice Address - Phone:402-216-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician