Provider Demographics
NPI:1356757637
Name:WONG, ASHLEY (AUD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 HOSPITAL DR
Mailing Address - Street 2:SUITE LL-10
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4479
Mailing Address - Country:US
Mailing Address - Phone:612-339-2836
Mailing Address - Fax:
Practice Address - Street 1:9825 HOSPITAL DR
Practice Address - Street 2:SUITE LL-10
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4479
Practice Address - Country:US
Practice Address - Phone:612-339-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9090231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist