1740580984 NPI number — ASHLEY SUSANN WARD M.S. CCC-SLP

Table of content: ASHLEY SUSANN WARD M.S. CCC-SLP (NPI 1740580984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740580984 NPI number — ASHLEY SUSANN WARD M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
ASHLEY
Provider Middle Name:
SUSANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARD
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
B.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740580984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BRISTOL RD APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02155-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-855-9303
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BRISTOL RD APT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02155-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-855-9303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 8766 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)