Provider Demographics
NPI:1629550991
Name:WALDVOGEL, ASHLEY ROSE (MS CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSE
Last Name:WALDVOGEL
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2514
Mailing Address - Country:US
Mailing Address - Phone:516-462-2350
Mailing Address - Fax:
Practice Address - Street 1:622 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2374
Practice Address - Country:US
Practice Address - Phone:631-240-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program