Provider Demographics
NPI:1548819626
Name:GREGORY, ASHLEIGH LUCY ANNETTE (BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:LUCY ANNETTE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHARLESBANK RD APT 5
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1732
Mailing Address - Country:US
Mailing Address - Phone:815-355-0837
Mailing Address - Fax:
Practice Address - Street 1:524 N MADISON ST # 2
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3364
Practice Address - Country:US
Practice Address - Phone:815-909-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-22-58149103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst