Provider Demographics
NPI:1780172338
Name:ALLEN, ASHLEY CAMILLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAMILLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E 12300 S STE C-493
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7976
Mailing Address - Country:US
Mailing Address - Phone:801-784-8137
Mailing Address - Fax:
Practice Address - Street 1:138 E 12300 S STE C-493
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7976
Practice Address - Country:US
Practice Address - Phone:801-784-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD263561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical