Provider Demographics
NPI:1275331514
Name:LEAVY, ASHTON LAURYN (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:LAURYN
Last Name:LEAVY
Suffix:
Gender:
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:ASHTON
Other - Middle Name:LAURYN
Other - Last Name:LEAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:25 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2326
Mailing Address - Country:US
Mailing Address - Phone:917-524-4684
Mailing Address - Fax:
Practice Address - Street 1:2907 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2008
Practice Address - Country:US
Practice Address - Phone:347-896-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034761-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist