Individual
ASHLEY KISSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD, STE 774, PORT ORANGE, FL 32128-8311
(800) 330-7711
(866) 426-2811
Mailing address
53 HARDEN DR, LAGRANGEVILLE, NY 12540-6323
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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