Provider Demographics
NPI:1124573761
Name:WEAVER, ASHLEY (AUD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WEAVER
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 1:1010 NORTHERN BLVD
Mailing Address - Street 2:#308
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 NORTHERN BLVD
Practice Address - Street 2:#308
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5317
Practice Address - Country:US
Practice Address - Phone:516-708-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002646231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist