Provider Demographics
NPI:1386420107
Name:VALDERRAMA, ASHLEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:VALDERRAMA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 HIGHWAY 515 S
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4872
Mailing Address - Country:US
Mailing Address - Phone:706-692-9016
Mailing Address - Fax:706-253-0177
Practice Address - Street 1:1266 HIGHWAY 515 S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4872
Practice Address - Country:US
Practice Address - Phone:706-692-9016
Practice Address - Fax:706-253-0177
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist