Provider Demographics
NPI:1669706032
Name:CHADWICK, ASHLEY E
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 377
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-9531
Mailing Address - Country:US
Mailing Address - Phone:229-588-0011
Mailing Address - Fax:
Practice Address - Street 1:1701 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2940
Practice Address - Country:US
Practice Address - Phone:229-244-4545
Practice Address - Fax:229-244-4244
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007186235Z00000X
FL22682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist