Provider Demographics
NPI:1861021461
Name:WALTZ, ASHLEY (BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WALTZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:WALTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:4778 OVERTON RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3803
Mailing Address - Country:US
Mailing Address - Phone:205-957-0294
Mailing Address - Fax:205-957-0294
Practice Address - Street 1:4778 OVERTON RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-3803
Practice Address - Country:US
Practice Address - Phone:205-957-0294
Practice Address - Fax:205-957-0298
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-20-115558106S00000X
AL12477181103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALRBT-20-115558OtherBACB CERTIFICATION FOR RBT