1184715096 NPI number — MRS. ASHLEY PASEMAN KELLEY MA CCC SLP

Table of content: MRS. ASHLEY PASEMAN KELLEY MA CCC SLP (NPI 1184715096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184715096 NPI number — MRS. ASHLEY PASEMAN KELLEY MA CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLEY
Provider First Name:
ASHLEY
Provider Middle Name:
PASEMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA 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:
PASEMAN
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA CCC SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184715096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7506 STRAWBERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANLIUS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13104-9758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-559-2478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3906 E GENESEE ST
Provider Second Line Business Practice Location Address:
VOCAL POINTE
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13214-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-559-2478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006

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: 235Z00000X , with the licence number:  0110511 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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