Provider Demographics
NPI:1912451527
Name:WATHEN, ASHLYN STOUT
Entity Type:Individual
Prefix:MRS
First Name:ASHLYN
Middle Name:STOUT
Last Name:WATHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:ELIZABETH
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:665 OLD LEITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378-9446
Mailing Address - Country:US
Mailing Address - Phone:270-313-3819
Mailing Address - Fax:
Practice Address - Street 1:665 OLD LEITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42378-9446
Practice Address - Country:US
Practice Address - Phone:270-313-3819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist