Provider Demographics
NPI:1639867252
Name:KASARJIAN, ASHBY KATHLEEN
Entity Type:Individual
Prefix:
First Name:ASHBY
Middle Name:KATHLEEN
Last Name:KASARJIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-8842
Mailing Address - Country:US
Mailing Address - Phone:334-301-5669
Mailing Address - Fax:
Practice Address - Street 1:205 GRACELAND DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7347
Practice Address - Country:US
Practice Address - Phone:334-793-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist