Provider Demographics
NPI:1821681263
Name:WOLLER, ASHLEY (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WOLLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DICKINSON RD
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1844
Mailing Address - Country:US
Mailing Address - Phone:732-609-7671
Mailing Address - Fax:
Practice Address - Street 1:3050 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4901
Practice Address - Country:US
Practice Address - Phone:718-405-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14337938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist