Provider Demographics
NPI:1487891172
Name:STAFFORD, ASHLEA D (MA/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEA
Middle Name:D
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:MS
Other - First Name:ASHLEA
Other - Middle Name:D
Other - Last Name:OURS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:2805 HUNTSMAN CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8649
Mailing Address - Country:US
Mailing Address - Phone:336-455-3467
Mailing Address - Fax:
Practice Address - Street 1:3907A W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1303
Practice Address - Country:US
Practice Address - Phone:336-279-9008
Practice Address - Fax:336-740-9099
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005589235Z00000X
NC8020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-6720Medicare PIN