Provider Demographics
NPI:1275191041
Name:EISON, ASHLYNN DEESE (M ED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:DEESE
Last Name:EISON
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:ASHLYNN
Other - Middle Name:SHAE
Other - Last Name:DEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-6562
Mailing Address - Country:US
Mailing Address - Phone:678-372-0525
Mailing Address - Fax:
Practice Address - Street 1:2455 OAK GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-9513
Practice Address - Country:US
Practice Address - Phone:770-834-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist