Provider Demographics
NPI:1306276126
Name:ALLEN, ASHLEY GARDNER (MS, SPED)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:GARDNER
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1730
Mailing Address - Country:US
Mailing Address - Phone:518-463-4801
Mailing Address - Fax:
Practice Address - Street 1:14379 RT 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143
Practice Address - Country:US
Practice Address - Phone:518-756-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03288117Medicaid