Basic Information
| Provider Information | |||||||||
| NPI: | 1427582667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLISZCZEWICZ | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARTINO | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1811 CORNELL AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232263560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153743598 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8254 ATLEE RD | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231161844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047641000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2017 | ||||||||
| LastUpdateDate: | 04/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202007005 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.