Provider Demographics
NPI:1780239780
Name:MARTIN, ASHLEY JANE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 TWIN ARCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCK TAVERN
Mailing Address - State:NY
Mailing Address - Zip Code:12575-5327
Mailing Address - Country:US
Mailing Address - Phone:845-496-3897
Mailing Address - Fax:
Practice Address - Street 1:228 WARD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1270
Practice Address - Country:US
Practice Address - Phone:845-293-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist