Provider Demographics
NPI:1396780995
Name:AL-IZZI, ASHLEY CARLOTTA (MS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CARLOTTA
Last Name:AL-IZZI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CARLOTTA
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:5821 S SPRAGUE CT
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6903
Mailing Address - Country:US
Mailing Address - Phone:253-396-4250
Mailing Address - Fax:253-396-4260
Practice Address - Street 1:12911 120TH AVE NE STE E40
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3045
Practice Address - Country:US
Practice Address - Phone:425-821-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004507231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000060Medicaid
CAGAU000060Medicaid