Basic Information
| Provider Information | |||||||||
| NPI: | 1942708581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEIKIRK | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73A LAKESIDE VILLA | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619516400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188381018 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619519490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177284327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2018 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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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 | 242.004673 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.