Provider Demographics
NPI:1295938363
Name:LANKSTER-MATTOX, ASHLEY PAIGE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:PAIGE
Last Name:LANKSTER-MATTOX
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GAINSWAY DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8509
Mailing Address - Country:US
Mailing Address - Phone:859-887-9773
Mailing Address - Fax:
Practice Address - Street 1:132 GAINSWAY DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8509
Practice Address - Country:US
Practice Address - Phone:859-887-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist