Provider Demographics
NPI:1770713612
Name:MCDERMOTT, ASHLEY (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N AVON AVE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1207
Mailing Address - Country:US
Mailing Address - Phone:440-625-0802
Mailing Address - Fax:440-625-0803
Practice Address - Street 1:570 N ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1613
Practice Address - Country:US
Practice Address - Phone:440-625-0802
Practice Address - Fax:440-625-0803
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist