Provider Demographics
NPI:1831653104
Name:EIDEM, ASHLEY (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:EIDEM
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NOELANI DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-1478
Mailing Address - Country:US
Mailing Address - Phone:814-691-4016
Mailing Address - Fax:
Practice Address - Street 1:437 GIVLER DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1635
Practice Address - Country:US
Practice Address - Phone:814-793-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist