Provider Demographics
NPI:1417113432
Name:WILLETT, ASHLEY SYNAN (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:SYNAN
Last Name:WILLETT
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 DORSET BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6014
Mailing Address - Country:US
Mailing Address - Phone:336-207-0653
Mailing Address - Fax:
Practice Address - Street 1:5950 DORSET BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135
Practice Address - Country:UM
Practice Address - Phone:336-207-0653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8065235Z00000X
GASLP011422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist