Provider Demographics
NPI:1992172100
Name:WILLIS, ASHLEY (SLP-CCC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0114
Mailing Address - Country:US
Mailing Address - Phone:423-622-1551
Mailing Address - Fax:
Practice Address - Street 1:695 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2472
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5689OtherTN HEALTH LICENSE