Provider Demographics
NPI:1982045258
Name:LUCKEY, ASHLEY ROCKETT (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ROCKETT
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 PARSONS PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4186
Mailing Address - Country:US
Mailing Address - Phone:336-880-0224
Mailing Address - Fax:
Practice Address - Street 1:2000 SALEMTOWNE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3488
Practice Address - Country:US
Practice Address - Phone:336-776-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist