Provider Demographics
NPI:1629275672
Name:PHILLIPS, ASHLEY MICHELE (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MICHELE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-6917
Mailing Address - Country:US
Mailing Address - Phone:270-952-2297
Mailing Address - Fax:
Practice Address - Street 1:25 S BOEHNE CAMP RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3101
Practice Address - Country:US
Practice Address - Phone:812-423-7468
Practice Address - Fax:812-423-7568
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142350235Z00000X
IN22004432A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155238Medicare ID - Type Unspecified