MEDICARE: ASHLEY DEFINE 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
1	235Z00000X	Speech-Language Pathologist	2009206-SP	OH
2	235Z00000X	Speech-Language Pathologist	SP.09591	OH

General Provider Information

NPI Number	:	1629204730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DEFINE SLP

Provider Business Mailing Address
First Line	:	526 EVERHARD RD SW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44709-1020
Country	:	US
Telephone Number	:	330-620-3975
Fax Number	:

Provider Business Practice Location Address
First Line	:	7171 KECK PARK CIR NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-6301
Country	:	US
Telephone Number	:	330-498-8200
Fax Number	:

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

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	09/14/2022

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Directions to “ ASHLEY DEFINE SLP” Practice Location

Language	Start Address	Practice Location

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