Healthcare Provider Details

I. General information

NPI: 1396671525
Provider Name (Legal Business Name): ASHLEY OTOOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 OLD REDWOOD HWY
SANTA ROSA CA
95403-1719
US

IV. Provider business mailing address

7616 WATSON DR
ROHNERT PARK CA
94928-4064
US

V. Phone/Fax

Practice location:
  • Phone: 707-393-4000
  • Fax:
Mailing address:
  • Phone: 707-246-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: