Provider Demographics
NPI:1902350648
Name:HOLWERDA, ASHLEY M (MA BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:HOLWERDA
Suffix:
Gender:F
Credentials:MA BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 LARAWAY RIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6608
Mailing Address - Country:US
Mailing Address - Phone:248-470-7971
Mailing Address - Fax:
Practice Address - Street 1:1545 68TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-7896
Practice Address - Country:US
Practice Address - Phone:248-470-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000192103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst