Provider Demographics
NPI:1801218433
Name:MICHAELIS, ASHLEY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:MICHAELIS
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 1:10950-60 SAN JOSE BLVD
Mailing Address - Street 2:#268
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-539-9330
Mailing Address - Fax:904-395-2255
Practice Address - Street 1:10950-60 SAN JOSE BLVD
Practice Address - Street 2:#268
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-539-9930
Practice Address - Fax:904-395-2255
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0134112235Z00000X
FLSA12742235Z00000X
FLSA20132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist