Provider Demographics
NPI:1629414560
Name:GANGEMI, ASHTON ELIZABETH (MA)
Entity Type:Individual
Prefix:MISS
First Name:ASHTON
Middle Name:ELIZABETH
Last Name:GANGEMI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 PRINCESS PATH
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2025
Mailing Address - Country:US
Mailing Address - Phone:315-593-4148
Mailing Address - Fax:
Practice Address - Street 1:269 E 8TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3355
Practice Address - Country:US
Practice Address - Phone:315-341-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-19
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist