Provider Demographics
NPI:1174705016
Name:ASHLEY, MICHELLE L (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 LUNA BELLA LN
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5346
Mailing Address - Country:US
Mailing Address - Phone:386-314-3542
Mailing Address - Fax:386-423-4056
Practice Address - Street 1:478 LUNA BELLA LN
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-5346
Practice Address - Country:US
Practice Address - Phone:386-314-3542
Practice Address - Fax:386-423-4056
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA00003749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist