Provider Demographics
NPI:1053655050
Name:PARKER, ASHLEY A
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:PARKER
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 1:14286 BEACH BLVD
Mailing Address - Street 2:SUITE 34
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1561
Mailing Address - Country:US
Mailing Address - Phone:904-345-7512
Mailing Address - Fax:904-345-7540
Practice Address - Street 1:14286 BEACH BLVD
Practice Address - Street 2:SUITE 34
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1561
Practice Address - Country:US
Practice Address - Phone:904-345-7512
Practice Address - Fax:904-345-7540
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012038834235Z00000X
FLSA 13154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist