Provider Demographics
NPI:1295575421
Name:GUILLAUME, ASHLEY ANN (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-7038
Mailing Address - Country:US
Mailing Address - Phone:515-460-2962
Mailing Address - Fax:
Practice Address - Street 1:425 S 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-7038
Practice Address - Country:US
Practice Address - Phone:515-460-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty