Provider Demographics
NPI:1669025748
Name:BOUGHTER, ASHLEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BOUGHTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:188 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:16133-2802
Mailing Address - Country:US
Mailing Address - Phone:724-967-4932
Mailing Address - Fax:
Practice Address - Street 1:120 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1544
Practice Address - Country:US
Practice Address - Phone:724-458-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLO14201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist