Provider Demographics
NPI:1790090223
Name:GALLETTA, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GALLETTA
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 1:2336 WISTERIA DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6191
Mailing Address - Country:US
Mailing Address - Phone:770-995-9600
Mailing Address - Fax:770-736-7699
Practice Address - Street 1:2336 WISTERIA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6191
Practice Address - Country:US
Practice Address - Phone:770-995-9600
Practice Address - Fax:770-736-7699
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003113777AMedicaid