Provider Demographics
NPI:1114492212
Name:HEATHERLY, ASHLEY ELIZABETH (CLC)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:HEATHERLY
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:TASSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CLC
Mailing Address - Street 1:6867 FM 1136
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-6547
Mailing Address - Country:US
Mailing Address - Phone:409-238-1028
Mailing Address - Fax:
Practice Address - Street 1:6867 FM 1136
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-6547
Practice Address - Country:US
Practice Address - Phone:409-238-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL253746174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN