Provider Demographics
NPI:1013434968
Name:JORGENSON, ASHLEY WYNNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:WYNNE
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MICHELLE
Other - Last Name:WYNNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:61 W GRAND ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2160
Mailing Address - Country:US
Mailing Address - Phone:516-302-3533
Mailing Address - Fax:
Practice Address - Street 1:1861 ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5903
Practice Address - Country:US
Practice Address - Phone:718-583-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist