Provider Demographics
NPI:1720450893
Name:NOWOTKA, ASHLEY (SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:NOWOTKA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1826
Mailing Address - Country:US
Mailing Address - Phone:419-708-6625
Mailing Address - Fax:
Practice Address - Street 1:6900 HALL ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9485
Practice Address - Country:US
Practice Address - Phone:419-708-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2016013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist