Provider Demographics
NPI:1053914499
Name:THORGESON, ASHLEY (BCABA, SCABA)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:THORGESON
Suffix:
Gender:F
Credentials:BCABA, SCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 SIEGEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1914
Mailing Address - Country:US
Mailing Address - Phone:225-757-8002
Mailing Address - Fax:225-757-8822
Practice Address - Street 1:8180 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1914
Practice Address - Country:US
Practice Address - Phone:225-757-8002
Practice Address - Fax:225-757-8822
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC-083106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst