Provider Demographics
NPI:1972748002
Name:ASHMAN, COLLEEN MARIE (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARIE
Last Name:ASHMAN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:RUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1225 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1542
Mailing Address - Country:US
Mailing Address - Phone:607-343-8661
Mailing Address - Fax:
Practice Address - Street 1:1225 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1542
Practice Address - Country:US
Practice Address - Phone:607-343-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011522-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist