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NPI Code Detail

MEDICARE: ASHLYNN DEESE EISON M. ED., CCC-SLP

MEDICARE: ASHLYNN DEESE EISON M. ED., CCC-SLP
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
1235Z00000XSpeech-Language PathologistSLP010629GA

General Provider Information

NPI Number : 1275191041
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLYNN DEESE EISON M. ED., CCC-SLP
Provider Business Mailing Address
First Line : 76 SALEM CHURCH RD
Second Line :
City : CARROLLTON
State : GA
Zip : 30117-6562
Country : US
Telephone Number : 678-372-0525
Fax Number :
Provider Business Practice Location Address
First Line : 2455 OAK GROVE CHURCH RD
Second Line :
City : CARROLLTON
State : GA
Zip : 30117-9513
Country : US
Telephone Number : 770-834-1737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2019
Last Update Date : 06/18/2019

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