Provider Demographics
NPI:1013548700
Name:GONZALEZ, ASHLEY CAITLIN (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:CAITLIN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7750
Mailing Address - Country:US
Mailing Address - Phone:870-333-3649
Mailing Address - Fax:
Practice Address - Street 1:3215 SPRINGWOOD DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7750
Practice Address - Country:US
Practice Address - Phone:870-333-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14130226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty