MEDICARE: ASHLEY TACKETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1003364357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY TACKETT

Provider Business Mailing Address
First Line	:	210 N COOPER AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-3011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N COOPER AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-3011
Country	:	US
Telephone Number	:	513-563-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	03/10/2021

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Directions to “ ASHLEY TACKETT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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