Individual
MRS. ASHLEY NICOLE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
27 ST LAWRENCE DR STE 104, TIFFIN, OH 44883-8313
(419) 455-8600
Mailing address
1101 W TOWNSHIP ROAD 150, TIFFIN, OH 44883-9446
(419) 618-9202
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP.13448
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14323703
ASHA
—
01
—
COND.2018630-SP
OHIO SPEECH LANGUAGE THERAPY LICENSE NUMBER
OH
01
—
SP.13448
OHIO SPEECH LANGUAGE THERAPY LICENSE NUMBER
OH
Enumeration date
11/14/2018
Last updated
05/27/2020
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