Provider Demographics
NPI:1912231291
Name:WILLSON, ASHLEY B (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:B
Last Name:WILLSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:B
Other - Last Name:DOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 BARCELONA DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-469-6511
Mailing Address - Fax:
Practice Address - Street 1:19 WARDS LN
Practice Address - Street 2:MENANDS UFSD
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204
Practice Address - Country:US
Practice Address - Phone:518-465-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018999235Z00000X
ASHA12096083235Z00000X
NYNYSLICENSE01899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist