Provider Demographics
NPI:1831609700
Name:MOTIKA ROOME, ASHLEY CLAIRE
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:CLAIRE
Last Name:MOTIKA ROOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CLAIRE
Other - Last Name:MOTIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4523 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6743
Mailing Address - Country:US
Mailing Address - Phone:330-647-1714
Mailing Address - Fax:
Practice Address - Street 1:1619 11TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3143
Practice Address - Country:US
Practice Address - Phone:309-743-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist