Basic Information
| Provider Information | |||||||||
| NPI: | 1700386729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GINEMAN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, BCBA, COBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | GINEMAN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, BCBA, COBA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3070 RIVERSIDE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432212547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146155145 | ||||||||
| FaxNumber: | 6145917620 | ||||||||
| Practice Location | |||||||||
| Address1: | 3070 RIVERSIDE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432212547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146155145 | ||||||||
| FaxNumber: | 6145917620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2018 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | COBA.00399 | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.