Provider Demographics
NPI:1609561075
Name:NYE, ASHLYN ROSE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:ROSE
Last Name:NYE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 GLEN ECHO WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-8708
Mailing Address - Country:US
Mailing Address - Phone:541-613-4604
Mailing Address - Fax:
Practice Address - Street 1:4674 TOWN CENTER PKWY APT 460
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8921
Practice Address - Country:US
Practice Address - Phone:541-613-4604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist