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General NPI Number Information
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NPI Number | 1518776426
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Entity Type | Organization
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Legal Business Name | ASHLAND ELECTROLYSIS & SKIN AESTHETICS, LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 570B FAIRVIEW ST
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City | ASHLAND
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State | OR
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Zip | 97520-2967
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Country | US
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Telephone | 541-488-3262
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Fax | 866-292-0549
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Provider Business Mailing Address
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Address Line | PO BOX 577
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City | ASHLAND
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State | OR
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Zip | 97520-0020
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Country | US
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Telephone | 541-488-3262
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MOLLY BALLEW
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Credential | LE, LFT
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Telephone | 541-488-3262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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