Provider Demographics
NPI:1023330461
Name:MACHEN, ASHLEY JAMISON LANCE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JAMISON LANCE
Last Name:MACHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 US HIGHWAY 341 S
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9582
Mailing Address - Country:US
Mailing Address - Phone:478-251-3708
Mailing Address - Fax:
Practice Address - Street 1:2263 US HIGHWAY 341 S
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9582
Practice Address - Country:US
Practice Address - Phone:478-251-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist