Provider Demographics
NPI:1740859198
Name:WOODBURY, ASHLEY RENEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:WOODBURY
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 1:40 DEWAYNS WAY
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2098
Mailing Address - Country:US
Mailing Address - Phone:207-420-1524
Mailing Address - Fax:
Practice Address - Street 1:12 ROBIE ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1710
Practice Address - Country:US
Practice Address - Phone:207-222-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST3495235Z00000X
MESP3678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist