Provider Demographics
NPI:1346406857
Name:BACON, ASHLEY I (AUD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:I
Last Name:BACON
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0655
Mailing Address - Country:US
Mailing Address - Phone:603-766-6400
Mailing Address - Fax:603-766-6415
Practice Address - Street 1:200 GRIFFIN RD
Practice Address - Street 2:STE 16
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7145
Practice Address - Country:US
Practice Address - Phone:603-766-6400
Practice Address - Fax:603-766-6415
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA566231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist