Provider Demographics
NPI:1740339704
Name:VORMWALD, ASHLEY C (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:C
Last Name:VORMWALD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-0500
Mailing Address - Country:US
Mailing Address - Phone:607-749-1226
Mailing Address - Fax:
Practice Address - Street 1:9 CENTRAL PARK PLACE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077
Practice Address - Country:US
Practice Address - Phone:607-749-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-10-29
Deactivation Date:2015-06-17
Deactivation Code:
Reactivation Date:2020-09-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist