Provider Demographics
NPI:1790418192
Name:MCGOUGH, ASHLEY NICHOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MANGUS CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-6533
Mailing Address - Country:US
Mailing Address - Phone:814-248-6087
Mailing Address - Fax:
Practice Address - Street 1:144 MANGUS CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-6533
Practice Address - Country:US
Practice Address - Phone:814-248-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist