Provider Demographics
NPI:1205283215
Name:LIGENZOWSKI, ASHLEY MCCOY (MSP,CCC-SLP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MCCOY
Last Name:LIGENZOWSKI
Suffix:
Gender:F
Credentials:MSP,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 STONEY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9388
Mailing Address - Country:US
Mailing Address - Phone:910-520-5787
Mailing Address - Fax:
Practice Address - Street 1:1042 STONEY WOODS LN
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9388
Practice Address - Country:US
Practice Address - Phone:910-520-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist