Provider Demographics
NPI:1104450527
Name:PARKS, ASHLEY ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:PARKS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3420 AMBER MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8390
Mailing Address - Country:US
Mailing Address - Phone:330-883-9970
Mailing Address - Fax:
Practice Address - Street 1:B-19-1 RAFFLESIA CONDOMINIUM
Practice Address - Street 2:JALAN 6/48A
Practice Address - City:KUALA LUMPUR
Practice Address - State:KUALA LUMPUR
Practice Address - Zip Code:51000
Practice Address - Country:MY
Practice Address - Phone:016-736-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist