Healthcare Provider Details

I. General information

NPI: 1538090428
Provider Name (Legal Business Name): ASHLEY ELAINE WOMBLE ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY ELAINE CLARK ED.S.

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 IRWIN ST STE 251
MELBOURNE FL
32901-7316
US

IV. Provider business mailing address

1352 HARVARD CIR APT 201
MELBOURNE FL
32905-2244
US

V. Phone/Fax

Practice location:
  • Phone: 407-782-3380
  • Fax:
Mailing address:
  • Phone: 407-782-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1439476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: