MEDICARE: MRS. ASHLEIGH MARIE GUDGEON MA, LPC

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	101YP2500X	Professional Counselor	LPC-13571	AZ

General Provider Information

NPI Number	:	1801192356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEIGH MARIE GUDGEON MA, LPC

Provider Business Mailing Address
First Line	:	16742 W MOHAVE ST
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85338-7369
Country	:	US
Telephone Number	:	623-570-5068
Fax Number	:

Provider Business Practice Location Address
First Line	:	17505 N 79TH AVE
Second Line	:	STE 111E
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8725
Country	:	US
Telephone Number	:	480-254-6395
Fax Number	:

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

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	02/01/2011

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