Provider Demographics
NPI:1083126429
Name:CHAMPAGNE, ASHLYN BROOK (MS)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:BROOK
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75100 MEDITERRANEAN
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9069
Mailing Address - Country:US
Mailing Address - Phone:760-837-0033
Mailing Address - Fax:
Practice Address - Street 1:75100 MEDITERRANEAN
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9069
Practice Address - Country:US
Practice Address - Phone:760-837-0033
Practice Address - Fax:760-837-1013
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty