Provider Demographics
NPI:1053599183
Name:BENNETT, ASHLEY NICHOLE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICHOLE
Other - Last Name:GRIMSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2383 ROAD C
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:KS
Mailing Address - Zip Code:66835-9532
Mailing Address - Country:US
Mailing Address - Phone:620-794-4179
Mailing Address - Fax:
Practice Address - Street 1:1106 N 155TH ST STE B
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:913-662-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00588103K00000X
KS086103K00000X
1-13-12733103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00588OtherBEHAVIOR SCIENCES REGULATORY BOARD
1-13-12733OtherBEHAVIOR ANALYST CERTIFICATION BOARD