Provider Demographics
NPI:1184715096
Name:KELLEY, ASHLEY PASEMAN (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:PASEMAN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:PASEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:7506 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9758
Mailing Address - Country:US
Mailing Address - Phone:315-559-2478
Mailing Address - Fax:
Practice Address - Street 1:3906 E GENESEE ST
Practice Address - Street 2:VOCAL POINTE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1934
Practice Address - Country:US
Practice Address - Phone:315-559-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0110511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist