Provider Demographics
NPI:1003572520
Name:ASHLEY BRETHEL SPEECH-LANGUAGE PATHOLOGY PLLC
Entity type:Organization
Organization Name:ASHLEY BRETHEL SPEECH-LANGUAGE PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-748-6232
Mailing Address - Street 1:54 ACE CT
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2002
Mailing Address - Country:US
Mailing Address - Phone:631-748-6232
Mailing Address - Fax:
Practice Address - Street 1:54 ACE CT
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2002
Practice Address - Country:US
Practice Address - Phone:631-748-6232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3848666Medicaid