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General NPI Number Information
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NPI Number | 1609561075
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Entity Type | Individual
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Provider Name | ASHLYN ROSE NYE M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 4674 TOWN CENTER PKWY APT 460
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8921
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Country | US
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Telephone | 541-613-4604
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Fax |
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Provider Business Mailing Address
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Address Line | 4654 GLEN ECHO WAY
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City | CENTRAL POINT
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State | OR
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Zip | 97502-8708
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Country | US
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Telephone | 541-613-4604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA20467
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License Number State | FL
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