MEDICARE: MRS. ASHLEY RAE COLWELL

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	SA13363	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962939702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY RAE COLWELL

Provider Business Mailing Address
First Line	:	17759 128TH TRL N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-4604
Country	:	US
Telephone Number	:	561-452-2086
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 N RIDGEWOOD DR STE C
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-7205
Country	:	US
Telephone Number	:	786-332-6632
Fax Number	:	305-418-7578

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	09/29/2021

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