Provider Demographics
NPI:1073156543
Name:FABIAN, ASHTON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:FABIAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 EBENEZER RD STE H
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1069
Mailing Address - Country:US
Mailing Address - Phone:803-661-5033
Mailing Address - Fax:864-643-2327
Practice Address - Street 1:2025 EBENEZER RD STE H
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1069
Practice Address - Country:US
Practice Address - Phone:803-661-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist