Provider Demographics
NPI:1962939702
Name:COLWELL, ASHLEY RAE
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RAE
Last Name:COLWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17759 128TH TRL N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-4604
Mailing Address - Country:US
Mailing Address - Phone:561-452-2086
Mailing Address - Fax:
Practice Address - Street 1:326 N RIDGEWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7205
Practice Address - Country:US
Practice Address - Phone:786-332-6632
Practice Address - Fax:305-418-7578
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist