Provider Demographics
NPI:1073200861
Name:CLANCY-GAGNON, ASHLEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:CLANCY-GAGNON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 NORTH ST APT 41
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4618
Mailing Address - Country:US
Mailing Address - Phone:860-558-4151
Mailing Address - Fax:
Practice Address - Street 1:510 NORTH ST STE 6
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5493
Practice Address - Country:US
Practice Address - Phone:413-447-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist