Provider Demographics
NPI:1457321465
Name:ASHBY, JON KENNETH (PHD CCC SLPA)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:KENNETH
Last Name:ASHBY
Suffix:
Gender:M
Credentials:PHD CCC SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 REGIONAL PLAZA
Mailing Address - Street 2:STE 850
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:325-698-9048
Mailing Address - Fax:325-698-9060
Practice Address - Street 1:6300 REGIONAL PLAZA
Practice Address - Street 2:STE 850
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-698-9048
Practice Address - Fax:325-698-9060
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50365231H00000X
TX11764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80140AOtherINSURANCE BCBS
TX514062Medicare ID - Type Unspecified
TX80140AOtherINSURANCE BCBS