Provider Demographics
NPI:1194046706
Name:ROLL, ASHLEY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:ROLL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 LEE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5551
Mailing Address - Country:US
Mailing Address - Phone:407-730-6988
Mailing Address - Fax:407-730-6995
Practice Address - Street 1:933 LEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5551
Practice Address - Country:US
Practice Address - Phone:407-730-6988
Practice Address - Fax:407-730-6995
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002501900Medicaid