MEDICARE: ASHLEY KOHUT 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
1	235Z00000X	Speech-Language Pathologist	SP.09480	OH

General Provider Information

NPI Number	:	1760124283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KOHUT M.A.CCC-SLP

Provider Business Mailing Address
First Line	:	5251 HARMONY LN
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4305
Country	:	US
Telephone Number	:	440-867-6323
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 LANDERHAVEN DR
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4129
Country	:	US
Telephone Number	:	216-245-3661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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