Provider Demographics
NPI:1710168174
Name:CARROLL, ASHLEY DAWN
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:DAWN
Last Name:CARROLL
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 1:652 SHIPLEY SCHOOL RD
Mailing Address - Street 2:CW SHIPLEY ELEM SCHOOL JEFFERSON COUNTY SCHOOLS
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425
Mailing Address - Country:US
Mailing Address - Phone:304-725-4395
Mailing Address - Fax:304-728-7388
Practice Address - Street 1:652 SHIPLEY SCHOOL RD
Practice Address - Street 2:CW SHIPLEY ELEM
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425
Practice Address - Country:US
Practice Address - Phone:304-725-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007415Medicaid