Provider Demographics
NPI:1639769110
Name:MADRAY, ASHLYN TAYLOR (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:TAYLOR
Last Name:MADRAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:TAYLOR
Other - Last Name:HOCKENSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4212 CORAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3016
Mailing Address - Country:US
Mailing Address - Phone:912-342-8875
Mailing Address - Fax:912-342-8016
Practice Address - Street 1:171 NW CHERRY LN
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1308
Practice Address - Country:US
Practice Address - Phone:912-342-8875
Practice Address - Fax:912-342-8075
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist