Most Relevant Information
Provider Data
| NPI Number: | 1003231770 |
| Provider Name: | ASHLEY FAGAN |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | SZ6413 |
Most Important Dates
| Enumeration Date: | 03/04/2014 |
| Last Updated: | 03/04/2014 |
Provider Practice Location
3110 OAKBRIDGE BLVD E
LAKELAND
FL
338035987
Practice Location Phone/Fax
| Phone: | 8636484800 |
| Fax: |
Provider Mailing Location
101 E STATE ST
KENNETT SQUARE
PA
193483109
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |