Healthcare Provider Details

I. General information

NPI: 1831229566
Provider Name (Legal Business Name): ASHLEY PIQUETTE M.ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 THREE WEST PKWY
VILLA RICA GA
30180-4778
US

IV. Provider business mailing address

112 THREE WEST PKWY
VILLA RICA GA
30180-4778
US

V. Phone/Fax

Practice location:
  • Phone: 770-459-6533
  • Fax: 770-462-1260
Mailing address:
  • Phone: 770-459-6533
  • Fax: 770-462-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP003031
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: