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NPI Code Detail

MEDICARE: ASHLEY KOUBA M.A., CCC-SLP

MEDICARE:   ASHLEY  KOUBA  M.A., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2009006674NE

General Provider Information

NPI Number : 1255691416
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY KOUBA M.A., CCC-SLP
Provider Business Mailing Address
First Line : 1501 THURSTON AVE
Second Line :
City : BELLEVUE
State : NE
Zip : 68123-2498
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1501 THURSTON AVE
Second Line :
City : BELLEVUE
State : NE
Zip : 68123-2498
Country : US
Telephone Number : 402-293-4074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2012
Last Update Date : 05/22/2012

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Directions to “ ASHLEY KOUBA M.A., CCC-SLP” Practice Location

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