Provider Demographics
NPI:1497948855
Name:PETERSON SCONZO, ASHLEY PAIGE JORDAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:PAIGE JORDAN
Last Name:PETERSON SCONZO
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 14742
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4042
Mailing Address - Country:US
Mailing Address - Phone:512-258-2300
Mailing Address - Fax:512-904-2294
Practice Address - Street 1:11645 ANGUS RD STE B8
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4100
Practice Address - Country:US
Practice Address - Phone:512-258-2300
Practice Address - Fax:512-904-2294
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4188237600000X
CO562237600000X
KS2136237600000X
TX80356237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90459776Medicaid