Healthcare Provider Details

I. General information

NPI: 1568655769
Provider Name (Legal Business Name): ASHLEY A.P. WYKLE M.S.ED, CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY A. POWERS MS, CF/SLP

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 LASKIN RD
VIRGINIA BEACH VA
23451-6007
US

IV. Provider business mailing address

509 MOCKINGBIRD DR
VIRGINIA BEACH VA
23451-5201
US

V. Phone/Fax

Practice location:
  • Phone: 757-403-2923
  • Fax:
Mailing address:
  • Phone: 757-403-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: