Provider Demographics
NPI:1568096824
Name:GARDO, ASHLEY ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:GARDO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1141
Mailing Address - Country:US
Mailing Address - Phone:304-329-3908
Mailing Address - Fax:304-329-3918
Practice Address - Street 1:150 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1141
Practice Address - Country:US
Practice Address - Phone:304-329-3908
Practice Address - Fax:304-329-3918
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSLP-1451OtherSTATE LICENSE